Dr. Gerald Kirshenbaum - Considering Dr. Kirshenbaum

[KayleighsMommy 16]

For the next challenge:

I am going to MI in April, and really want to be down 75 pounds by then... which leaves me 10 to go, so please put my challenge amount down as 10 pounds.

Thanks.

[julie.ann 1]

April 1st Challenge

Minidriver ------(Goal -10lbs) -4.5, , , , , ,

Lap_dancer-----(Goal -33lbs) , ..., , , , ,

Deboregon -----(Goal -15lbs) -2.6, , , , , ,

Julie.Ann -------(Goal -19lbs) -4.9, , , , , ,

PrtyAntOvrYt---(Goal -30lbs) -4.2, , , , , ,

BellaPerdente--(Goal -12lbs) 0.0,. , , , , ,

Lotzasunshine--(Goal -12lbs) , .., , , , ,

Jmegirl----------(Goal -15lbs) -2.6, , , , , ,

KaleighsMommy-(Goal -10lbs) ,. , , , , ,

[PrtyAntOvrYt 6]

Hi all,

I haven't been around for awhile. I have been a bit down. For the last few months my abdomen has getting bigger and bigger (right over my belly button) I look pregnant (and I didn't even look pregnant when I was 5 years ago!!! ) Anyway, when this started in November I went to see Dr Metz (my surgeon) for a fill and showed him my belly. At first he said he thought it was a big hernia, then he said it might just be "architecture <sp> " of my body, he suggested I go to my pcp to order a CT san. He also told me if I did have a hernia he would not repair it til I got down to a 40BMI.

Anyway... I finally had the CT scan a couple of weeks ago, and my pcp called to tell me I had a very large hernia (no big suprise). I figured I would have to lose about 28 pounds to be at a 40 BMI for the surgery. I knew that was doable in a fairly short amount of time. I was going to see if I could get a paniulectomy done at the same time. I was somewhat excited about possibly having surgery (and this is something for me... seeing how very, very badly the lap band/hernia repair went for me last year) I went to see Dr Metz, and he agreed the hernia is really large. He also told me he would not repair it til I am at a 35 BMI . This means I need to lose another 60 some pounds. At my slow 1 pound a week average (If I'm lucky) it is going to be over a year before I can have this repair done. I told him it hurts... a LOT (which it does) but he told me getting it repaired any time soon will just cause it to tear again (this is my third hernia in the same place, my surgery was the end of June, and it was back by the end of October I understand the reasoning of him wanting me to be under a 35 BMI, but I am still quite upset and bummed about this whole thing. <sigh>

I am tempted to go to a different surgeon, but....

1) I don't want a non band surgeon poking around in there.

2) I really do believe him when he says it will come back, due to the size of my belly, and I have done some poking around online and am fairly sure my insurance will not pay for a paniulectomy at this time (it seems most insurance companies do not consider recurrect hernias enough to pay for the surgery)

I guess I'll just have to wait and put up with the pain

If you're still reading... thanks for listening to my whining :huh2:

kayleigh's Mom!

I am so sorry to hear about your hernia! That's is horrible! I know you must be so disappointed! Especially since he told her he'd do the surgery with a BMI of 40 and then change his mind to 35. I do think that the pannis could be causing this, but I can't say I have evidence of this belief.

My insurance won't pay for mine either. There is an exception to any procedure done by a plastic surgeon. I wonder if they would pay for it if a different doctor did it. (anyway, I digress)

Will your insurance cover the hernia repair? What if Dr. Metz could give proof that if you don't get your pannis removed that you'll continue getting hernias. I wonder if he could send a letter to the insurance. If the pannis could be removed at the time of the hernia repair that would save the insurance money.

I'm sorry you're in pain!

[KayleighsMommy 16]

kayleigh's Mom!

I am so sorry to hear about your hernia! That's is horrible! I know you must be so disappointed! Especially since he told her he'd do the surgery with a BMI of 40 and then change his mind to 35. I do think that the pannis could be causing this, but I can't say I have evidence of this belief.

My insurance won't pay for mine either. There is an exception to any procedure done by a plastic surgeon. I wonder if they would pay for it if a different doctor did it. (anyway, I digress)

Will your insurance cover the hernia repair? What if Dr. Metz could give proof that if you don't get your pannis removed that you'll continue getting hernias. I wonder if he could send a letter to the insurance. If the pannis could be removed at the time of the hernia repair that would save the insurance money.

I'm sorry you're in pain!

Thanks for the reply, I asked Dr Metz about being able to send it to the insurance as a medical need due to the hernias... he was just like "well, if you get it done now you will need more skin removed when you get to goal." My feeling?? so???? I would rather have the pannus removed now and pay for a mini Tummy Tuck in a year or so. He told me my stomach alone is about 25 pounds... so that would put me somewhat closer to goal (not to mention how I would look and feel. I have been so down.... 65 pounds gone and I am still wearing the same jeans as pre-surgery due to my large pannus... granted I no longer look like I have a butt in the front in these jeans... but jeez... how much weight do I need to lose???

[PrtyAntOvrYt 6]

Thanks for the reply, I asked Dr Metz about being able to send it to the insurance as a medical need due to the hernias... he was just like "well, if you get it done now you will need more skin removed when you get to goal." My feeling?? so???? I would rather have the pannus removed now and pay for a mini Tummy Tuck in a year or so. He told me my stomach alone is about 25 pounds... so that would put me somewhat closer to goal (not to mention how I would look and feel. I have been so down.... 65 pounds gone and I am still wearing the same jeans as pre-surgery due to my large pannus... granted I no longer look like I have a butt in the front in these jeans... but jeez... how much weight do I need to lose???

i totally know how you feel. i'm 140lbs less and i wear almost the same size jeans because of my huge pannis. i consulted with dr. wolfe in cherry creek and he sees it the way we do. get rid of the pannis and then you will feel better, move better and be able to be more active and comfortable in your own 'skin' -- (pun intended) he was very sweet about it. he also asked me to get as close to a bmi of of 40, before surgery, however, he said IF i couldn't handle the back aches he'd do it now and then i'd just get the tummy tuck when i get to goal.

i think for people like you and me and Patty, we have to have our surgeries in phases. it makes more sense!

[KayleighsMommy 16]

Dee-

I remember you mentioning something about that Red Robin. If I may ask...is this Dr a plastic surgeon?? I really don't know if I could afford PS right now... unless someone is willing to document that I need this surgery because of the recurrent hernias.

[PrtyAntOvrYt 6]

Dee-

I remember you mentioning something about that Red Robin. If I may ask...is this Dr a plastic surgeon?? I really don't know if I could afford PS right now... unless someone is willing to document that I need this surgery because of the recurrent hernias.

My insurance had a total exclusion for plastic surgery. This doc is a plastic surgeon and he comes very highly recommended. He is willing to petition my insurance to pay, even though I know they will not. He gave me a quote for self pay to get my arms and panni done. I can let you know if you PM - what that quote was. He also is offering a 20% discount for 90days that started Feb 1st for his services. The quote he gave me included everything, anesthesia and everything else.

[Guest BikiniBeachy]

Hey Dee! How are you? I forgot your screen name so I am so glad to catch up! Looks like you are doing well yourself! I look forward to seeing everyone at Red Robin again, please keep me posted.

I just bought a Wii Fit and Wii on the internet! I can barely contain my excitement for it to get here, and I also ordered Jillian Michael's game! Nice!

Julie I am so so so sorry you are dealing with all that. You are going to come out of all this the strongest Julie possible! lol! I hope things get sorted out fast, will you be at Red Robin next time? I hope so. How is Kayleigh? Work?

and Julie.ann...can I join the challenge? My birthday is March 31st so I'd love to try and be down 12 by then! I am so so so close to Onederland, and hope I can get there in April!!!

[julie.ann 1]

April 1st Challenge

Minidriver ------(Goal -10lbs) -4.5, , , , , ,

Lap_dancer-----(Goal -33lbs) , ..., , , , ,

Deboregon -----(Goal -15lbs) -2.6, , , , , ,

Julie.Ann -------(Goal -19lbs) -4.9, , , , , ,

PrtyAntOvrYt---(Goal -30lbs) -4.2, , , , , ,

BellaPerdente--(Goal -12lbs) 0.0,. , , , , ,

Lotzasunshine--(Goal -12lbs) , .., , , , ,

Jmegirl----------(Goal -15lbs) -2.6, , , , , ,

KaleighsMommy-(Goal -10lbs) ,. , , , , ,

BikiniBeachy-----(Goal -12lbs) ,. , , , , ,

[Lap_dancer 8]

kayleigh's Mom!

I am so sorry to hear about your hernia! That's is horrible! I know you must be so disappointed! Especially since he told her he'd do the surgery with a BMI of 40 and then change his mind to 35. I do think that the pannis could be causing this, but I can't say I have evidence of this belief.

My insurance won't pay for mine either. There is an exception to any procedure done by a plastic surgeon. I wonder if they would pay for it if a different doctor did it. (anyway, I digress)

Will your insurance cover the hernia repair? What if Dr. Metz could give proof that if you don't get your pannis removed that you'll continue getting hernias. I wonder if he could send a letter to the insurance. If the pannis could be removed at the time of the hernia repair that would save the insurance money.

I'm sorry you're in pain!

Kayleigh's Mom I too am sorry for your pain. Please be persistant in following through until you have remedy. Sometimes the NO is fate's way of sending us in another direction. I got a NO here in Florida and persisted and ultimately found Dr. K. How fortunate fate was on my side.

This subject brings to mind insurance companies. Did anyone see the movie "The Rainmaker"? The storyline involves a young lawyer who takes the case of a family whose son has lukemia. Their insurance company continually denied coverage to prevent from having to pay for the care that a young man diagnosed with leukemia needs. In the end the young man is too ill to even appear in court and it is feared he won't live long enough to see his case to trial.

It's a really dark and seedy look into some practices by some insurance companies. In the case of the movie, it was disclosed they denied coverage on a regular basis hoping the policy holder would give up.

I always get copies of my reports when any test is done. I keep them in a file in the event I need them.

To those who have insurance, your policy/coverage is most likely online. The details of your coverage are online as well. When you get a NO from insurance, it may be something as simple as a word, a sentence structure, which lead to the denial of your coverage. True story:....

Most of you know I went to the Cleveland Clinic for my back. My insurance policy does not cover anything weight loss related. That is, if I go into a doctor seeking assistance with WEIGHT LOSS as my PRIMARY cause for going to the doctor, it is not covered.

I was referred to a plastic surgeon while at the Cleveland Clinic to look at my pannus ( the thing that hangs from your stomach and swings and is all skin and fat) to see if removing it would assist in my problems with the lumbar region of my back. I saw the surgeon, he advised not to have the surgery at this time but continue losing the weight. His rationale was that my BACK would be relied on to support myself after the surgery. It simply is too weak at this point.

I got a bill from the insurance company that coverage was denied. I called the billing department at my insurance company and they said it was denied because of the diagnosis: morbid obesity. That's was true right? But after reading the above information, that isn't ALL of the story as to why I went to see him. They advised me to call the doctor and ask if he could resubmit a different code.

I called the hospital billing department. They had the doctor's medical transcription on their computer system and could read his notes from my visit. Sure enough, the first sentence of his transcription was that I was there referred by the Spine Institute, consulation for panniculectomy for possible relief.

The submitted the information, he changed the code and the $458 bill was paid by insurance.

Learning as much as you can about all things related to you, including your insurance, what is covered, what is not, calling and asking WHY something is being denied, or, better still, asking for a 'a medically based reason my request for coverage was denied' may change the scenerio.

Hope this helps.

[Lap_dancer 8]

Hello Friends:

I did not lose any weight this week. BLAH. I'm also not doing the FITDAY. I'll keep the account but to be honest, trying to eat when I don't feel like eating, trying to eat Protein, as recommended, when my port/stoma is in small mode and bulky chicken doesn't want to go down, isn't working for me. It seemed to throw my whole routine out of whack and my body became irregular by Wednesday. I'll stick to what seems to be working for me now that I have my meds under control.

My pain is diminishing as each week goes by. Between my weight going down, the pain medication regulated to my pain level, I find more and more energy coming. I actually stood and did the dishes, cleaned off the counters, put away 'stuff' for 20 minutes last Monday. On Thursday we had dinner at mothers house. I was able to stand and start cleaning the supper dishes up!

*For those of you who do not know me, this is short of a miracle*. STANDING in one place is something I use to liken to an older western scene where the victim lay grimacing on a cot saying..."give me a bullet, a shot of whiskey and the grip of a strong armed man so I can get through this". Each week is better and better.

I had some drama with my mother this week. She is in the hospital, taken by ambulence on Thursday. She has a lump removed from her breast on Tuesday. She was taken off her Kumadin (sp?) and from Sunday to Thursday she did not have this blood thinning medicine. End result was a build up of Fluid on her chest, she has had congestive heart failure, this time she was in the early stages of it so they put her on oxygen and kept her for four days. She is out now but that explains my absence this week.

[KayleighsMommy 16]

Kayleigh's Mom I too am sorry for your pain. Please be persistant in following through until you have remedy. Sometimes the NO is fate's way of sending us in another direction. I got a NO here in Florida and persisted and ultimately found Dr. K. How fortunate fate was on my side.

This subject brings to mind insurance companies. Did anyone see the movie "The Rainmaker"? The storyline involves a young lawyer who takes the case of a family whose son has lukemia. Their insurance company continually denied coverage to prevent from having to pay for the care that a young man diagnosed with leukemia needs. In the end the young man is too ill to even appear in court and it is feared he won't live long enough to see his case to trial.

It's a really dark and seedy look into some practices by some insurance companies. In the case of the movie, it was disclosed they denied coverage on a regular basis hoping the policy holder would give up.

I always get copies of my reports when any test is done. I keep them in a file in the event I need them.

To those who have insurance, your policy/coverage is most likely online. The details of your coverage are online as well. When you get a NO from insurance, it may be something as simple as a word, a sentence structure, which lead to the denial of your coverage. True story:....

Most of you know I went to the Cleveland Clinic for my back. My insurance policy does not cover anything weight loss related. That is, if I go into a doctor seeking assistance with WEIGHT LOSS as my PRIMARY cause for going to the doctor, it is not covered.

I was referred to a plastic surgeon while at the Cleveland Clinic to look at my pannus ( the thing that hangs from your stomach and swings and is all skin and fat) to see if removing it would assist in my problems with the lumbar region of my back. I saw the surgeon, he advised not to have the surgery at this time but continue losing the weight. His rationale was that my BACK would be relied on to support myself after the surgery. It simply is too weak at this point.

I got a bill from the insurance company that coverage was denied. I called the billing department at my insurance company and they said it was denied because of the diagnosis: morbid obesity. That's was true right? But after reading the above information, that isn't ALL of the story as to why I went to see him. They advised me to call the doctor and ask if he could resubmit a different code.

I called the hospital billing department. They had the doctor's medical transcription on their computer system and could read his notes from my visit. Sure enough, the first sentence of his transcription was that I was there referred by the Spine Institute, consulation for panniculectomy for possible relief.

The submitted the information, he changed the code and the $458 bill was paid by insurance.

Learning as much as you can about all things related to you, including your insurance, what is covered, what is not, calling and asking WHY something is being denied, or, better still, asking for a 'a medically based reason my request for coverage was denied' may change the scenerio.

Hope this helps.

Lap dancer, Thanks for your reply. You are very correct on the insurance issue.... it can be near impossible. When I first applied for my lap band and my surgeons office called they were told "Oh yea, no problem... no pre requisites, no copay, no deductible" etc. Then I got a denial that I needed a 6 month diet first, then I got a denial that I needed a 2 year diet :tt1: Every time I called I got someone else with a different answer. It was sooooo frustrating . I couldn't understand how an insurance company could hire so many idiots. Well.... now I am one of those idiots (working as customer service for a insurance co) and I fully understand it. Most people have no freaking idea what they are talking about when they quote your benefits, so persevering may get you somewhere, too bad it may only get you a hernia. I need to call my insurance company to get them to send me a schedule of benefits, since I can't seem to find mine online. I am going to just bypass the "insurance idiots" and read my benefits for myself. This is something I really believe would be beneficial to me, so I am going to have to just get in there and fight the good fight.

[lotzasunshine 2]

April 1st Challenge

Minidriver ------(Goal -10lbs) -4.5, , , , , ,

Lap_dancer-----(Goal -33lbs) , ..., , , , ,

Deboregon -----(Goal -15lbs) -2.6, , , , , ,

Julie.Ann -------(Goal -19lbs) -4.9, , , , , ,

PrtyAntOvrYt---(Goal -30lbs) -4.2, , , , , ,

BellaPerdente--(Goal -12lbs) 0.0,. , , , , ,

Lotzasunshine--(Goal -12lbs) , .., , , , ,

Jmegirl----------(Goal -15lbs) -2.6, , , , , ,

KaleighsMommy-(Goal -10lbs) ,. , , , , ,

BikiniBeachy-----(Goal -12lbs) ,. , , , , ,

You can just put me down for +1.5 last week. When are we weighing btw?

[magaines 0]

Lap dancer, Thanks for your reply. You are very correct on the insurance issue.... it can be near impossible. When I first applied for my lap band and my surgeons office called they were told "Oh yea, no problem... no pre requisites, no copay, no deductible" etc. Then I got a denial that I needed a 6 month diet first, then I got a denial that I needed a 2 year diet :cursing: Every time I called I got someone else with a different answer. It was sooooo frustrating :smile: . I couldn't understand how an insurance company could hire so many idiots. Well.... now I am one of those idiots (working as customer service for a insurance co) and I fully understand it. Most people have no freaking idea what they are talking about when they quote your benefits, so persevering may get you somewhere, too bad it may only get you a hernia. I need to call my insurance company to get them to send me a schedule of benefits, since I can't seem to find mine online. I am going to just bypass the "insurance idiots" and read my benefits for myself. This is something I really believe would be beneficial to me, so I am going to have to just get in there and fight the good fight. :cool2:

Julie:

I haven't been on for a long time, so it has taken me better than a couple hours to get caught up. I am so sorry to hear that you are having such a crappy time. I'm sure that you will be able to sort thru your insurance benefits better than any of the customer service reps you can get on the phonem maybe you will find a little golden nugget.:thumbup:

[Fluffy_Gurl 3]

Sorry for the interuption!(sp) I was hoping that some of you may have a few ideas or suggestions for me. I know that you all have been banded by dr.k and i was wondering how you were able to self pay. i understand that this may be a personal question but i am still brainstorming on how i can make this happen for me. If i am going to have he surgery I will have to self pay. My question is how am i going to do it. I know that where there is a will there is a way so..i am still searching for my way. I am considering applying for financing, however, i do not have the best credit as i went through a spell where finainces were difficult and i got behind on an old credit card payment and student loan payments and am now trying o catch back up and repay them in a timely manner and am almos there, I am also working my way towards trying to find a better paying job...i was actually told after an interviewrecently by someone who worked at the place i interviewed at that the company i interviewed with doesnt hire fat ppl..nice right? i so wish i could prove it because it is wrong on so many levels it would be nice if someone could take a stand..anyway not really the purpose for the post so please excuse the small rant...

So, How did you pay for your surgery?