NEED YOUR INPUT MY FRIENDS!

Hello Friends

I had my consultation with a pretty well known and 5 star rated dr. today in Orange County, CA. Here's what occurred:

1. Although I am 238 lbs at 5'2, he thought I should just do Protein shakes? Huh? He also talked about the fact that my insurance only pays him around $900 for the surgery. Is this something I need to know? I think not.

2. I had a RY lap gastric bypass 9 yrs ago. He said there is no way to redo a gastric bypass NOR have a gastric sleeve. Is this true?

3. He said I will only lose around 25 lbs with a lap band. Is this possible? If so, why?

He has no tests yet as he ordered them today after we met. He didn't ask about my gall bladder either.

I have Tri Care Prime so my choices are limited.

So what do you think of all this AND can you recommend an Orange County, CA bariatric surgeon who takes TriCare Prime? Thank you all!!

APR

My cousin had RNY and later got the band she is in NY. She is doing great. There are reasons that RNY is not always the end all. For her the pouch stretched out to hold about a cup however with a strange angle the food would slide right through, now with the band that does not happen. I think everyone is different and you should get more opinions from professionals that deal with patients that have both.

Best of Luck

Theresa

NEED YOUR INPUT MY FRIENDS!

Hello Friends

I had my consultation with a pretty well known and 5 star rated dr. today in Orange County, CA. Here's what occurred:

1. Although I am 238 lbs at 5'2, he thought I should just do Protein shakes? Huh? He also talked about the fact that my insurance only pays him around $900 for the surgery. Is this something I need to know? I think not.

2. I had a RY lap gastric bypass 9 yrs ago. He said there is no way to redo a gastric bypass NOR have a gastric sleeve. Is this true?

3. He said I will only lose around 25 lbs with a lap band. Is this possible? If so, why?

He has no tests yet as he ordered them today after we met. He didn't ask about my gall bladder either.

I have Tri Care Prime so my choices are limited.

So what do you think of all this AND can you recommend an Orange County, CA bariatric surgeon who takes TriCare Prime? Thank you all!!

APR

I have an MBA and I am a Nuclear Engineer.

Education level does not equal success at weight loss or understanding of the mental challenges faced. I do see a therapist. I wish I was in as good a shape mentally as you are as my journey would be so much easier.

IMHO, if I were the surgeon you visited and you explained your story to me I would also not recommend a second surgery at this time. It sounds like the surgeon you visited is acting ethically and in your and his best interests.

Btw, my insurance will not cover a second surgery unless it is a removal due to band failure.

vic

I have an MBA and I am a Nuclear Engineer.

Education level does not equal success at weight loss or understanding of the mental challenges faced. I do see a therapist. I wish I was in as good a shape mentally as you are as my journey would be so much easier.

IMHO, if I were the surgeon you visited and you explained your story to me I would also not recommend a second surgery at this time. It sounds like the surgeon you visited is acting ethically and in your and his best interests.

Btw, my insurance will not cover a second surgery unless it is a removal due to band failure.

vic

Hi Vic,

Thx for your input. It is genuinely appreciated.

The reason I mention my education & successes is because many doctors (and some other professionals) talk down to obese patients. There is SOME TIMES (this is not an overarching statement) a sense that fat = stupid. We all know that is not true. With my JD, I am at least as educated as my -- no longer -- doctor so being honest and explaining his lack of expertise with revisions would have been accepted had he been forthright.

My insurance will pay for a revision because there seems to be at least two indicators that there was a problem with the original. Further, the insurance I have now was not the one I had 9 years ago.

Regarding ethics, while my former doctor might have some, I will be reporting him tomorrow to TriCare Prime. He is NOT allowed to ask for $500 to $3,500 in addition to the fee the insurance gives him for the surgery. That IS unethical and against the guidelines of many insurance policies. Second, I pride myself on my soft skills and I would NEVER talk to a client about my financial issues. It's simply inappropriate. If he is not getting enough from TriCare or other insurance companies, he shouldn't accept them. That's a simple business decision.

I continue to enjoy the give and take of information here even when I disagree. This is truly social media at its best.

M

Good luck and I hope you find someone.

My friend that had the revision had a serious hernia issue that required surgery. During the hernia repair, they performed another bypass. They did not perform the bypass just because he had regained the weight.

My surgeon will not remove the band unless there is a medical problem calling for removal. He will not do revisional surgery at all. Whatever his reasons, I respect his decision and I will work harder at making my band work.

As for insurance, I have a doctor that requires payment of any balance not covered by insurance and he is upfront with his policy. This may be why the surgeon you visited asked for the additional money. I have found this to be the case with higher rated/experienced physicians that I have seen. The screening paperwork I filled out prior to my first visit had this requirement specified.

Your insurance sounds much better than my ANTHEM insurance. I paid just over $1,000 out of pocket for my Lapband for the various individuals involved with my surgery and the hospital.

z

But do you tell your doctor you have an MBA? They talk down to people that let them. If your not happy with this surgeon then find another one. I would much prefer to know how much I need to pay out of pocket then not know at all. I would also call your insuance company because it could very well be an issue that you already had one bariatric surgery and it did not work they might not pay for a second. Life happens things happen but just because you get injured doesnt mean you have to gain back weight. I have issues with my knees and do not exercise but none the less I have not gained back any weight because I didnt go through this to regain my weight.

So I have been taking all of your words to heart....Absorbing....listening...thinking. I decided to go to Dr. Keshishian's website at around 7:30 pm last night...I kept reading about revisions and his name kept coming up.

I filled out the form on his site...including the copies of my insurance card and writing about my experience...my sense of failure. It's unfortunate that there is a lot of negativity when it comes to a person asking about a second surgical procedure.....

At 7:50 pm -- on a Sunday night -- my phone rang. Guess who? Dr. Keshishian himself. I cried. He asked why I was crying....I told him that I felt like a failure but had also heard he is one of the best at revisions.

He told me "It's not your fault"....explained the statistics and gave me more hope that I could ever imagined. We talked for about 15 minutes and he then said I would hear from someone in his ofc in a couple of days.

If this is ANY indication of what kind of man Dr. K is -- and if I am blessed to get a surgery approved by TriCare -- I will get my life back.

So instead of "no", "you can't", "it's your fault", the information I received from one of the top revision doctors in the country was positive, caring and factual. Soo....

Never say never...Always have hope and do not go quietly into the good night. I've annoyed a lot of people in my life by me being an overachiever...and this will be no different. I will bust my butt to make it happen and stay with it.

God bless those of you who gave me his name. He is less than 45 miles from my home so I can go there easily. Fingers crossed.

May all your dreams come true.

M

There are surgeons who do the "rose" revision for gastric bypass folks whose pouch has stretched.

As a healthcare professional, I do not think that it is ethical, nor particularly professional to discuss how much one makes on a surgery. Payment is his business / his office manager's (whomever negotiates his rates) and is negotiated between him / his manager and the insurance company. as is stated above, if he is not happy with the payment then he can choose not to take on the insurance.

Asking for additional monies to compensate him because he is unhappy with the insurance rate is not ideal nor by usual contract is this allowed (he should only take any co-pays/deductibles and then once that is met ony what the insurance pays out). However, he may have additional costs that he wishes to capture and if that is the case, then he should clearly communicate those items, i.e. additional costs not related to the surgery such as funding for post op support groups, assitant surgeon who does not take insurance, etc...

Most bariatric surgeons will do 3-6 bariatric cases per day. ($2,700-$5,400) not bad for 4.5-9 hours of work. True, this is only one day most surgeons will do surgery 2- 3 days (sometimes more frequently) / week. Not too bad for just a mere $900 / case.

Either way, I wish you luck!

Is it possible you misunderstood the added fees? I was 'accepted' into a Surgical program that had an extra $500 fee---this allows me to attend monthly support groups, unlimited meetings with a dietician, etc. I had no costs for the first 6 months post-surgery, not even a co-pay.

With regard to the 25 pounds comment---Most surgeons quote that a 'successful' banded patient will lose in the neighborhood of 40-60% of your EXCESS body weight. Thus, if he thought you should lose approximately 100 pounds, you will most likely lose (and keep off) between 40 and 60 pounds. Is it possible he did not think that having surgery was worth the risk for the possibility of only losing 25 pounds?

With all due respect, you sound very defensive. I assure you that MANY of the people I know out here are intelligent, hard working people. We are not lazy people who sat around eating bon-bons. We expect you're likely the same as the rest of us..... I didn't find my surgeon to be at all condescending. His entirely livelihood has been built on helping overweight people. Perhaps you expected, and thus were given, the worst?!