Can we start a thread for folks to post the cost of surgery (total fees) by the various doctors here in Alabama; not residual/recurring costs that would be incurred after being released from care?

It would be good public info if we can show Total Price, Amount Insurance Covered, Out-of-Pocket Costs.

I was banded in December 06. I was self pay. It cost me 13,900. This includes all doctor visits after surgery up until one year. That is all of my tightenings. After a year you have to pay for all of your tightenings.

Losingit07

I was banded by Dr Lane on March 6th 2006 in Mobile. Total self pay cost was $18,000. It is now 17 months later and he has not billed me for any of my monthly visits or adjustments.

I went to Dr. Miles seminar today.... St. Vincent's East, Birmingham .. and he stated that the cost is $13,900 total.. physician, hospital, everything, plus a year of follow up / fills. We were very impressed with the seminar and support group meeting they had today!! I live 2 hours from B'ham but at this point, I will be using that group.

Wendy

About to start 6 month physician supervised diet

I went to Dr. Miles seminar today.... St. Vincent's East, Birmingham .. and he stated that the cost is $13,900 total.. physician, hospital, everything, plus a year of follow up / fills. We were very impressed with the seminar and support group meeting they had today!! I live 2 hours from B'ham but at this point, I will be using that group.

Wendy

About to start 6 month physician supervised diet

Wendy - I started my 6 month physician supervised diet in June (I found about it in May). I was upset at first, but I took my brothers advice and decided to use this time to research MORE, start learning how and what to eat and begin an exercise regimen so that it's not so "shocking" to me when I have the surgery. They say it's 6 months - but you actually have to have 7 visits (to ensure 6 TOTAL months).

My surgery will be done by Dr. Schmitt - he was great and very informative. Did you make an appointment to see him? If so, you have to go to one of the lap-band support group meetings BEFORE your appointment but that was SUPER informative. I'll go again, just to get information. Also - this site is incredible! I have learned so so so much from people all over the world, but the ALabama area is my favorite cuz it just feels closer to home. Good luck with it all - I am anxiously awaiting my surgery.

I was banded in December 06. I was self pay. It cost me 13,900. This includes all doctor visits after surgery up until one year. That is all of my tightenings. After a year you have to pay for all of your tightenings.

Losingit07

Hey I was just wondering if Miles and Schmitt did your surgery? How are you doing on it so far? Can you tell us some of the good, great, not so good and horribles that you may have experienced? I know that is alot to ask, but it's nice to hear about. I know that is pesonal information and if you can't/don't share - that is perfectly fine

Thanks for the advice Janie. I wasn't sure if I should go ahead and schedule an in office consult with the surgeons or not. I'm not sure how long that consult is valid. Seems like after 6 months of not seeing them, they may want to start over but I'm not sure. I did email Veronica to see because I think it would be great to go ahead and see them to obtain the information on the foods I will be needing to eat and go ahead and get all the test done that will be required.

Have you been to the required nutrition class yet? We went to the seminar and support meeting yesterday and loved it. I am very grateful that they allowed pre op patients to come in!! But I do wonder if they have support meetings with only the post ops. Seems to me that with us pre oppers in there asking 10,000 questions, the post oppers don't really get the complete support they need at the meetings. We have a local support near Huntsville that I will be attending, but I'd love to go down and attend theirs too.

So what type foods are you adjusting to now? Increased your exercise? My husband and I went and purchased bike's yesterday. :biggrin1: I want to be as ready for this journey as I can be!! Needless to say we could probably video us riding and win $10,000 on AFV!! lol

Thanks for the advice Janie. I wasn't sure if I should go ahead and schedule an in office consult with the surgeons or not. I'm not sure how long that consult is valid. Seems like after 6 months of not seeing them, they may want to start over but I'm not sure. I did email Veronica to see because I think it would be great to go ahead and see them to obtain the information on the foods I will be needing to eat and go ahead and get all the test done that will be required.

Have you been to the required nutrition class yet? We went to the seminar and support meeting yesterday and loved it. I am very grateful that they allowed pre op patients to come in!! But I do wonder if they have support meetings with only the post ops. Seems to me that with us pre oppers in there asking 10,000 questions, the post oppers don't really get the complete support they need at the meetings. We have a local support near Huntsville that I will be attending, but I'd love to go down and attend theirs too.

So what type foods are you adjusting to now? Increased your exercise? My husband and I went and purchased bike's yesterday. :biggrin1: I want to be as ready for this journey as I can be!! Needless to say we could probably video us riding and win $10,000 on AFV!! lol

You can't schedule the nutrition class until you have your surgery date scheduled. I went ahead and met with Dr. Schmitt, some of the nurses and the finanicial person. She gives you everything you need to do before they will schedule the surgery. Blood work required, the forms that your physician needs to fill out the 6 months required by BCBS (they need those in your medical records), whether or not you need a sleep apnea test, and the psychologist appointment. I would go ahead and schedule it but be sure you're having your visits to the dr documented for BCBS.

Hey I was just wondering if Miles and Schmitt did your surgery? How are you doing on it so far? Can you tell us some of the good, great, not so good and horribles that you may have experienced? I know that is alot to ask, but it's nice to hear about. I know that is pesonal information and if you can't/don't share - that is perfectly fine

Dr. Schmitt did complete my surgery on December 18, 2006. He was so wonderful, I cannot even begin to explain how wonderful my experience was. I have lost 65 pounds. I am scheduled for another fill next week. I was too tight in May and in June he took some out of my band. This is September and I cant wait to get to my goal weight. Dr. Schmitt has always answered all of my question. This has been the best thing that has ever happened to me. I feel like a different person. I am 36 years old and feel like I did when I was in high school. The only bad thing was that when I was to tight I would throw up alot. I went back to the doctor and everything has been fine since. I have BC/BS of Alabama and it would not pay for my surgery. I was self pay. This has been the best money I have every spent.

Dr. Schmitt did complete my surgery on December 18, 2006. He was so wonderful, I cannot even begin to explain how wonderful my experience was. I have lost 65 pounds. I am scheduled for another fill next week. I was too tight in May and in June he took some out of my band. This is September and I cant wait to get to my goal weight. Dr. Schmitt has always answered all of my question. This has been the best thing that has ever happened to me. I feel like a different person. I am 36 years old and feel like I did when I was in high school. The only bad thing was that when I was to tight I would throw up alot. I went back to the doctor and everything has been fine since. I have BC/BS of Alabama and it would not pay for my surgery. I was self pay. This has been the best money I have every spent.

I hate to tell you this, but BCBS of Alabama started paying in April - but you have to go through a 6 month physician monitored time period before they will even look at your case. I freaked out at first because I did NOT want to wait that long, but I'm almost there - hoping that my surgery will be in December and I'm sure I'll be asking you a lot of questions. I was going to self pay as well, because our policy said "NO WEIGHT LOSS SURGERY INCLUDED IN THIS POLICY" but they changed it - I am using this time to get my testing done, focus on chewing and rethinking my habits for when I do have the band in place. My next step is beginning an exercise routine - ugh!! Please keep us updated - and thank you

I was glad to find this thread. I live in Auburn and will go to Mexico self pay on 9-28-07. I love knowing there are other Alabamians out there for me to keep up with. :bounce:

hey im in huntsville, i have aetna as primary and bcbs of alabama as secondary i have more questions about the 6 mth thing. and all

hey im in huntsville, i have aetna as primary and bcbs of alabama as secondary i have more questions about the 6 mth thing. and all

Hi! What questions do you have? I've been approved with BCBS of AL. Not sure about the requirements of Aetna but will be glad to help if I can. I am in Huntsville also.

Ok im having a hard time trying to find blue cross's info, my husband said that bcbs didnt cover the lapband only gastric, here are my aetna requirements

1. Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multidisciplinary surgical preparatory regimen):
   
   1. 
      
   2. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record. This physician-supervised nutrition and exercise program must meet all of the following criteria:
      
   3. Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and
      
   4. Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and
      
   5. Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records;
      

or

[*]Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions:

1. Consultation with a dietician or nutritionist; and
   
2. Reduced-calorie diet program supervised by dietician or nutritionist; and
   
3. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
   
4. Behavior modification program supervised by qualified professional; and
   
5. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.)
   

[*]and

[*]For members who have a history of severe psychiatric disturbance (schizophrenia, borderline personality disorder, suicidal ideation, severe depression) or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications, pre-operative psychological clearance is necessary in order to exclude members who are unable to provide informed consent or who are unable to comply with the pre- and postoperative regimen. Note: The presence of depression due to obesity is not normally considered a contraindication to obesity surgery

Is that the same as bcbs?? Also who is your surgeon? I started going to my pcp in january, I have gone every month for weigh ins, to talk about what im doing, how im doing etc, she has put me on weightloss med once but was only on it for 2 wks before heart dr took me off it, i havent seen a nutrionist yet (not sure if its mandatory or not) my pcp has me on a 1800-2200 cal diet. im afraid that i will end the 6 mths and then get denied. I also work out 3 times sometimes more a week. I have other questions I just cant think of right now lol. I do have messengers in case you would rather communicate via messengers.

Small world, I am going to a training in Huntsville this week. I went with my friend to Mexico last weekend to get her lapband. Travel was hell but everything else was great!

Cleone

Nina - Here is the policy for BCBS of AL. It looks like it's alot alike other than BC requires 6 COMPLETED months before submitting for approval, it also has BMI requirements, as most do. Is BCBS your primary or Aetna. NORMALLY... the secondary follows the primaries guidelines. I would call and ask the insurance company if that is so in WLS.

https://www.bcbsal.org/providers/policies/final/053.pdf