I have been looking around the boards for anyone from Georgia. Am I all alone here?:welldoneclap:

Bensdad, I went to a nutrionist that was in my book for BCBS, I only had to pay the $10 copay. I can find her name and number and you can contact her. I'm not sure what the charge would be if you went to her out of network. I did a quick search but couldn't find her. Can't remember her name. Will keep looking. If you have a network book, look and see if you have dietician's there.

By the way, Dr. Davis is great! I wish you luck. I remember reading something, I think it was on lapband.com about a group that helps you to file for an appeal with insurance if you are denied. I will look for that too.

I appreciate the information - I hope that it won't get to that point, but I want to be ready and educated just in case. I have been unable to find the nutritionist information anywhere in our Healthcare Provider information. I am going to try and contact our benefits department and see if they know exactly where to look...

Hello! *waves*

I actually looked into that doctor in Colorado but he wants me to use someone within driving distance should something go wrong. I've got two consultations lined up with doctors in Alabama. My first is on Tuesday. :biggrin1:

They are doing an ultrasound of my liver and gallblader, a breathing test to see if I have some sort of bacteria (and if so-I will have to take meds to get that cleared up before they can do surgery), and a psych exam.

Would anyone be willing to share what their psych exams was like? Speaking of sharing...I emailed a few friends today to give them an update on my Tuesday appointment and I accidently included my immediate boss on the email. Needless to say I was mortified, especially as my wording appeared rather vague I'm sure b/c she had no idea I was looking into this and the update was literally "So, I have to have a psych exam on Tuesday."

Oops. :embarassed:

My eval was on December 27th and very much like candy8360's experience. The interview consisted of about 20 minutes of me telling my history, my motivation and my expectations. Then there was a 400 question test that took about an hour. There are some odd questions on there, but she stated that they have been using this tool since the 1950's and it works. Some of the questions are really obvious as to what illness or issue they are for (self-esteem, paranoia, little green men taking over the world :-) ). She stated that, out of all the bariatric evals she has ever done, only one person required some additional counsleing and, after 2 sessions, they were approved. I believe that, as long as you are doing it for the right reasons, you won't have any problem with the evaluation.....

Yes - I would love to have the number - thank you so much!!!!

I am PM you the number

I had to do the same seminar. Not sure if each doctor does his own, but Dr. Davis was the one who did mine. You will probably find a lot of it repetetive to a lot of things you have already learned here, but it is a prerequisite to using emory. I did mine at the end of June and then made my first appt. with Dr. Davis that next week, the week of July 4th. One of the things that took me so long was that I had to schedule all the preop stuff, had to have a current physical, and my last physical had been over a year before. I had to wait like 6-8 weeks for my physical. Then set up my psych appt. Had to wait a week or so on that. I was under the impression that my insurance didn't require a nutrional evaluation, but emory insisted on that, so when I thought I had everything done, I had to do that as well. Then they submitted me for approval. I was approved in a week, and then had to go in for an endoscopy. I did that on Sept. 27. After that I had to go to a 3 hour nutrional class which you have to pay for out of pocket. It cost $180. I had to wait for the money to cover that. I FINALLY got it all done and my surgery was scheduled for Nov. 27 but then the surgeon had an emergency and they rescheduled me for Dec. 4th. Was quite a journey, believe me!!! But, I made it through. Hopefully it will not take you as long. It all depends on your circumstances. But I am sure you will have to follow the same procedures. Let me know how your seminar goes!

How was your first fill? Can you tell a difference?

I decided to use Dr. Lin. When I called they told me the first thing I have to do is attend a free seminar where they will handout the paperwork and other items I will need to proceed. The seminar is Feb. 21st and seems like a long time away. I would have hoped to be sending my info to the insurance company before then and getting things started. For other Dr. Lin patients, how was the seminar?

I am not a Dr. Lin patient, but all 3 surgeons at Emory hold the same seminar - they just take turns. The seminar is actually pretty uninformative because everything that I wanted to know I got from LapBand.com. My suggestion is to go ahead and visit your primary care physician, get them to get your weight and figure out your BMI. If you have any co-morbidities (High Blood Pressure, High Cholesterol, Diabetes, Fatigue, Sleep Apnea, Back and joint problems), make sure they include those and go ahead and get a letter of Medical Necessity. Contact your insurance company to get information on what will be covered. If your insurance will cover it at any point in time, go ahead and have the psych eval done - everyone has to have that done no matter what.

The seminar is necessary because that is your ticket to getting pre-approved for becoming a candidate. They will contact you shortly afterward to let you know that you are approved and you can schedule your meeting with your Dr.

Hope this helps!

Hi Bensdad,

I have the State Health Plan PPO through United Healthcare (my husband is a teacher) and there is an exclusion for any type of WLS. I spoke to UHC and after some back and forth (during which different people contradicted each other) I received a copy of our policy that states this. Not sure if you're on the exact same plan I am but that's why I am self-pay.

Best,

Viridescence

Hi All!

I am from Griffin, GA, about 40 miles South of Atlanta. I have started the journey and hopefully will not have many more hurdles. I did get frustrated recently because I contacted my insurance (State of Georgia Health Plan with United Healthcare) months ago with the Lap Band surgery code and I was told that a letter of medical necessity would be required and a 30 day (max) review by a committee. So I went to the seminar, got the letter from my Primary Care Physician, received approval from my cardiologist, met with Dr. Scott Davis at Emory and just completed the Psych Eval last week. But when I contacted UHC again regarding the nutrition eval, the lady stated that the State of GA would not cover any weight loss surgery.... PERIOD.

The nutrition eval is my last step. I still have to write out my diet history over the last few years, but that will be fairly straight forward. I am going to go ahead and continue with the process to see what happens. I am praying that the first person I spoke with was right!! Once I am approved I will have to go to the $180 nutrition class previously mentioned, have the battery of tests and the EGD, then I will be scheduled for the surgery.

For any of you that stated that you had to self pay, were any of those UHC on the State of GA Health plan?

Also, does anyone that had the surgery with the Emory group know where to find a certified dietician or nutritionist that doesn't cost the $120.00 that the Emory folks do?

Look forward to chatting with you all - Happy New Year!

I wanted to say hi to another Dr. K patient in Georgia. Do you go back for fills from him?

Hi Ugagirl--I was an UGA girl myself. I'm in Georgia just south of Atlanta, and I actually decided to go to Dr. Kirshenbaum in Colorado. I had my surgery on 12/19. I think he's great--very nice and highly qualified. He charges less than 10K, so even with flights, it's still much less than around here.

Good luck!

Hi Bensdad,

I have the State Health Plan PPO through United Healthcare (my husband is a teacher) and there is an exclusion for any type of WLS. I spoke to UHC and after some back and forth (during which different people contradicted each other) I received a copy of our policy that states this. Not sure if you're on the exact same plan I am but that's why I am self-pay.

Best,

Viridescence

Did you actually try and submit a claim or did you decide on self-pay on what they said?

Hi to hopefulgirl from someone else on the Westside -- I work at West Georgia.

If this has not been answered yet, yes it is typical to require two more more co-morbidities if your BMI is under 40.

Did you actually try and submit a claim or did you decide on self-pay on what they said?

I decided on self-pay after I saw the exclusion in the policy (I didn't believe what anybody told me since they had contradicted each other -- UHC's customer service did not impress me at all). Based on the research that I did, it seemed fruitless to fight when there was a specific WLS exclusion; in my mind, it would be different if they did cover it but denied my claim. I'd fight it then. But I doubt that the state will change its policy in time for me and I wanted to move ahead now. So, self-pay it was.

I have posted before but not for awhile. i finally got my insurance that i will have with this company for the long haul. I signed up for my first seminar today. going on jan 24 to dennis smith's seminar. has anyone used him?

i havent gotten any prices yet from him but he is the one that is closest to me and also uses kennestone hospital. i could use alll the advice i can get!

thanks

randiik

Hi! I haven't posted on the GA board before, but I am from East Cobb and having my surgery done at Dekalb Medical Center on Thurs. (1/10). I went to the surgery center for my pre-op today, and the center is really nice! Very swanky!

I start my 48 hour clear liquid, pre-op diet tomorrow. I am so excited to get the surgery. Anyway..just wanted to say hi!

Anyone know of a good psychologist?

It seems that the one I went to might not be licensed...?

Oh...in Georgia...North Atlanta area please?!

Is that what is causing your insurance holdup?

Here is what my doctor suggested and who I used. I didn't exactly think much of him at my visit but he leads Dekalb's support group and I liked him at the meeting I attended.

Dr. Ritz - 770-270-5488

Tucker, Georgia

He sets up his own appointments and calls you back.

Hey Bensdad, YES, I can tell a difference from my first fill. Where before the fill I was eating about half of my usual amount. Since the fill I am eating around 2 cups (maybe slightly more), but not near as much as I was eating. Yesterday at lunch, I ate too fast and filled up afterwards. I felt like a stuffed turkey and was very uncomfortable all evening. Today at lunch, I felt like I was still wanting to eat more, but I stopped myself and waited. That helped. I am feeling full now and threw out the rest of my leftovers. Do NOT want a repeat of yesterday!

And, I LOVE MY DR. My next fill visit was scheduled for 1/31/08. The office called to say that Dr. Davis had a seminar but they could reschedule me for 1/24. A week EARLIER (not later!!!). I'm not sure that I will need a big fill next time. I know that I'm not the norm. Most people that I've read about need two or three fills before they can feel restriction. I definitely have restriction. I can feel a lump in my lower throat / upper chest when I swallow, (especially if I don't take small bites) and I get the hiccups when I try to eat too fast and sometimes when I get full. I'm learning the limitations. It hasn't even been a week though, and I don't know how much settling my stomach will do and therefore how much more of a fill I will need on the 24th.

But, I know I'm supposed to be eating 1 cup, and can eat 2 right now. So, I'm sure I'll need more fill, but not sure I need a big one. I'll ask Dr. Davis what he planned on giving and then tell him how I'm feeling.

But, as I said, I am SO glad to have him as my dr. He's very nice, very smart, and is very encouraging.

Also, anyone interested in a free trial gym membership? The National Body Challenge by discovery health network has an 8 week body challenge. You get a trial membership good from Jan. 5 - March 2. I signed up last year and decided to buy a membership. I haven't gone as much as I should. And, they are limited on Bally's locations, but if you are anywhere near one, it's fun to have the free membership. My daughter got the free membership with me last year but did not sign up after the 8 weeks. She called me today and asked me to go online and sign her up, she's been gaining weight. So I signed her up today. Just thought it might help someone who might not know about it.