Got my first bill for fills. I had expected to pay $175 per fill. That's what they said it was going to be at the seminar. But they also tacked on a $53 office visit fee which was never discussed. Another clinic I phoned said they just have a flat $100 fee, whether you fill or not, so obviously all docs are different. I'm quite angry that this $53 fee was never discussed. And since my doc will only do .5 cc at a time, and I'm only at 3 cc's, it's gonna take a while for restriction = major moola.

That's my main gripe.

This is just an aside. I was supposed to get 90 days free fills. I mentioned that to my doc last time so he got me in a little earlier to cover that 90 days (as it was getting close to 90 days since my operation). I was actually booked for a fill 3 days past 90 days but figured the doc moved me earlier due to me asking about my free 90 days, so I thought all was Kosher. No, apparently not. When I phoned the person in charge of billing, since I was billed for this last fill, she beaked off at me, basically ranted and raved, would not let me get a word in edgewise (this was when I was still talking politely), and would not calm down. She had reacted as if I was screaming at her (which I was not).

I told her well, the doc moved me ahead to be covered by the free 90 days. She said it's not up to the doc, it's up to the people at the desk. Well, if the doc already moved me up earlier to "cover" it, I just can't understand what the problem is. I know it's 3 days later, but I thought all docs have a little leeway. Anyway, this is all very confusing probably, but aside from the confusion on the 90 days I'm quite upset at how she was talking to me.

About the extra office charge that was never discussed I told her, "FYI, maybe that should be discussed at your seminars."

I ended up crying due to how I was treated and my 3 year old son said, and I quote, "You let me come with you to the doctor's office next time and I won't let that happen again." So it was a sweet outcome to a horrible experience with the office lady from hell.

My fill Dr. does a slightly more aggresive first fill--then he goes to .5cc fills. He discussed it with my SIL and I when we went in, and he showed us a report from Allergan that showed stats on fills and unfills, and explained that it is causing much fewer unfills, and resulting issues.

He said his personal unfill rate had seriously dropped.....to be totally honest he gave us a percentage, but at the time it was nothing to me, so I let it go in one ear and out the other!

My first fill was as I say more aggressive, so when I went back in and he was only going to give me less than half the first one, I was totally bummed----and let me tell you--that .5cc's made a massive difference!! I have never had another fill, and still have restriction.

I am losing weight--albeit slower the closer I get to goal----but I am not gaining!

I have actually had people tell me that it is not possible, that as my stomach loses fat, it will be too loose, so apparently I am not losing any fat----but I put on my clothes and stand on my scale, and I know I am!

5cc.'s sounds miniscule, but when it is the right amount, it is enough!

I think I would go in face to face as you have been advised, and tell them, that you know every time you turn around they are adding a charge for something, so you need an itemized statement, outlining what the charges will be each time, so you can be prepared. Then discuss it with the Dr. He may be totally unaware!

Liking your Dr. is the biggest deal. Now if he is aware and does not care that you are unhappy with their practices--then you might not like him so much and want a change---but for now if you are happy with the Dr. himself, I would not change over the 5cc thing.

Kat

Straight from the manual: The manual Inamed says is to be given to the patient:

INSTRUCTIONS FOR USE: BAND ADJUSTMENT

Postoperatively, the surgeon may adjust the stoma size percutaneously by injecting or aspirating saline with the access port needle via the self-sealing access port.

The following are general guidelines for LAP-BAND System adjustments:

1. The initial postoperative adjustment should occur 4-6 weeks after the operation. In most cases, you will add 1-2 cc of saline to the 9.75 and 10 cm LAP-BAND, 2-3 cc to the VG LAP-BAND, and 4 cc to the 11 cm LAP-BAND.

2. The patient should be reviewed regularly (every 4-6 weeks) and weight and clinical status measured. If the weight loss has averaged less than 1 lb per week over the period and the patient indicates there is not excessive restriction to eating, a further increment of Fluid should be added (usually 0.3 - 0.5 ml)

3. Where the average weight loss between visits has been greater than 2 lbs per week, normally no additional fluid would be added.

4. If the weight loss has averaged between 1 and 2 lbs per week, additional fluid would be indicated if the patient feels he/she can eat too freely or finds difficulty in complying with the dietary rules.

5. Fluid would be removed from the system if there were symptoms of excessive restriction or obstruction, including excessive sense of fullness, heartburn, regurgitation and vomiting. If symptoms are not relieved by removal of the fluid, barium meal should be used to evaluate the anatomy.

Prior to doing an adjustment to decrease the stoma, review the patient's chart for total band volume and recent adjustments. If recent adjustments have not been compliant with nutritional guidelines, the patient my have a leaking band system, or may have a pouch enlargement or esophageal dilation due to stomal obstruction, band slippage or over-restriction.

Band system patency can be conformed by injecting saline into the band system, then immediately withdrawing it. An absence or decrease in fluid volume indicates a leak in the system may exist. The band may be evaluated for a leak using a radiopaque solution, such as Hypaque or Conray-43, flushing it from the band system after the evaluation. If pouch enlargement or band/stomach slippage is suspected, a limited upper GI with a samll amount of barium or gastrograffin can be used to evaluate the size of the pouch, the gastric stoma and the position of the band.

CAUTION: Insufficient weight loss may be a symptom of inadequate restriction (band too loose). Or, it may be a symptom of pouch or esohpageal enlargement, and may be accompanied by other symptoms, such as heartburn, regurgitation or vomiting. If this is the case, inflation of the band would not be appropriate.

The band internal diameter may be decreased approximately 0.5mm by adding an additional 0.4 cc of sterile saline. Excessive restriction may result in a closed stoma. Because of the possible complications that can occur with excessive restriction, a doctor familiar with the adjustment procedure must be available for several days post-adjustment to adjust the stoma in case of emergency.

Deflation (an increase in stoma size) is considered if the patient experiences frequent episodes of vomiting, is unable to swallow liquids or appropriate foods, or if there are medical indications for increasing nutrient intake. the internal diameter of the band can be increased approximatley 0.5mm by withdrawing 0.4 cc of the fluid. Elective deflation of the band is advisable in the following situations:

Pregnancy

Significant concurrent illness

General anesthesia

Remote Travel

Travel to areas where food or Water contamination is endemic.

Another question - if I change docs, what happens if something horrible goes wrong and I need surgery? I'm opening up a whole can of worms here.

If you had a nose job and it was big time botched....please tell me you wouldn't go back to that surgeon.

Same thing here. Any internal medicine doc/surgeon who has been trained by Inamed can do the band...or fix anything wrong with yours. It is not necessary to keep seeing the same doc for LIFE.

We live in a mobile society. Having the band doesn't mean you can't relocate or go on vacation.

I have the same info in my box of goodies----but the key words in reporting to Inamed, or anyone are the 3 biggies in guideline #1.

"IN MOST CASES". That gives them all the leeway they need.

If you truly like your Dr. give him a chance to discuss it with you. It IS harder to find a Dr. to treat anothers patient, that much is obvious from here on LBT---people are always looking for a Dr. when they move etc.

Try to clear the air face to face. BE NICE! You do not have to kiss her butt---but you are going to get further towards what it sounds like YOU want--being nice than going in with an attitude. And believe me I know how hard that can be!! Then talk to your Dr. if after all that is said and done, you can move on to another Dr.

But he did not botch your surgery--the Dr. and the nurse you are happy with-----find out about the accounting staff----try to work towards what you want. I know the situation has angered you---rightfully so....but like my Mom used to tell me----Don't cut off your nose to spite your face.

Try to work it through if you want to keep your Dr.

Kat

Thank you so much, everyone! Really, I do appreciate your time to comment on this for me.

GraceUtah - You know what? I didn't get any manual thingamabob about Inamed. I'm going to have to ask for one next time I'm in. Thank you soooo much for including all that information. It has really helped. :cursing:

Kat - yes, I do like my doc and nurse. I talked to the nurse today about what happened, and she knew it was coming because Crazy Accounting Lady told her I might be calling her. Yep, sure did. Nurse said the same thing - it was up to me to book the appointment within 90 days (which I kinda thought I had - anyway ...) Frustrating, but whatever, I guess I can see their point. I just wished they would have been very CLEAR on that point. I'm still used to the Canadian system and it's a lot different in the U.S. - you really got to look out for yourself down here.

I also discussed the extra $53 fee for the office visit I was unaware of and she said that they will make sure to discuss it in further seminars. She admitted that other people who paid out of pocket also expressed concern about extra fees they weren't aware of, and it's something they will address from now on. And she apologized on behalf of Crazy Accounting Lady which made me feel much better. I told her I paid a heck of a lot of money to be treated like that and I knew they worked together for quite a few years, but I still deserve respect and to not be talked to in that way. She agreed. Anyway, I just want to be treated like a human being, so that helped immensely.

Next time I'm in I'll talk to him about the fees too - not that they'll change it I'm sure, but just so they know I don't appreciate it and that it should be clear in their seminars.

I guess it kind of sounds like I'm being wishy washy on this issue. I just don't want to change docs, just in case something goes wrong, and I do like the hospital setting he's in. Also, there's not that many choices here in Little Rock. But I don't want to be treated like dirt, and I hope that my conversation with the nurse today cleared that issue up.

When do you go back to the Dr.?

Let us know what HE himself has to say about all this, I would be interested to know...

Hope it turns out well for you!!!

Kat

Kat - I'm 99.9 percent sure it's a lost cause. I talked it out with the nurse and she said pretty much the same thing but in a nicer way. I'm sure the doc won't have anything new to add. I guess the best thing that can possibly come out of this is a warning to anyone else getting banded to make absolutely sure what the costs are going into it (which I thought I did ...)

I will mention it again to the doc, and I'm going on March 4, so I'll let you know what he says (probably nothing!) grrrrr .... (silently steaming)

Got my first bill for fills. I had expected to pay $175 per fill. That's what they said it was going to be at the seminar. But they also tacked on a $53 office visit fee which was never discussed. Another clinic I phoned said they just have a flat $100 fee, whether you fill or not, so obviously all docs are different. I'm quite angry that this $53 fee was never discussed. And since my doc will only do .5 cc at a time, and I'm only at 3 cc's, it's gonna take a while for restriction = major moola.

That's my main gripe.

This is just an aside. I was supposed to get 90 days free fills. I mentioned that to my doc last time so he got me in a little earlier to cover that 90 days (as it was getting close to 90 days since my operation). I was actually booked for a fill 3 days past 90 days but figured the doc moved me earlier due to me asking about my free 90 days, so I thought all was Kosher. No, apparently not. When I phoned the person in charge of billing, since I was billed for this last fill, she beaked off at me, basically ranted and raved, would not let me get a word in edgewise (this was when I was still talking politely), and would not calm down. She had reacted as if I was screaming at her (which I was not).

I told her well, the doc moved me ahead to be covered by the free 90 days. She said it's not up to the doc, it's up to the people at the desk. Well, if the doc already moved me up earlier to "cover" it, I just can't understand what the problem is. I know it's 3 days later, but I thought all docs have a little leeway. Anyway, this is all very confusing probably, but aside from the confusion on the 90 days I'm quite upset at how she was talking to me.

About the extra office charge that was never discussed I told her, "FYI, maybe that should be discussed at your seminars."

I ended up crying due to how I was treated and my 3 year old son said, and I quote, "You let me come with you to the doctor's office next time and I won't let that happen again." So it was a sweet outcome to a horrible experience with the office lady from hell.

I HAD A SIMILARE SITUATION ON BEING TREATED BADLY AND PAYING HIGH FEES FOR NOT MUCH Fluid,MY DR ALSO NEVER LISENED TO ANY CONCERNS I HAD APPROCHED HIM ABOUT[THIS COUD HAVE BEEN BECAUSE HE DIDNT DO MY OPERATION,SO I NOW TRAVEL 550KMS TO SEE MY DR WHO DID MY OP,THE FLUID AMOUNTS ARE GREAT AND THE BEDSIDE MANNER IS FANTASTIC]I DONT KNOW WHY SOME DRS GET BIG EGO DRIVES AND TREAT PEOPLE LIKE CRAP.MONEY GOES TO THERE HEAD IM SURE OF IT.ANY WAY,IM HAPPY WHERE I AM NOW,ALLS GOING WELL.IF YOU DONT LIKE THE WAY YOUR BEING TREATED,LOOK AROUND AND FIND SOMEONE WHO CARES ABOUT YOU.:thumbup:

I'm going in tomorrow. I think what I'm going to do is show him the bill and say I thought I only had to pay $175 and I feel it was a misrepresentation (is that the right word?) on their part to say that, when I have to pay an extra $55 for the office visit, and then see what he has to say. How does that sound? Any advice? I don't want to piss him off entirely - I'm not sure I can find any other docs around in my area. I already tried two and one was over $700 and the other isn't taking patients.

I think if you go in and ask him in a manner that is not accusing---and give him a chance to respond----you should be ok, even if you don't get the answer you desire.

Then you have a clear picture of where he stands, and whether he is involved at all. Then if you want to change, you can seriously begin looking, and then I would write letters saying they misrepresent the costs involved.

Let us know!

Kat

UPDATE:

Great news! I told my doc about the 90 day thing and he said okay, I'll talk to Kay about it (crazy billing lady). Then I said well, actually, there's one more thing - and told him about the $53 office visit and how I was told $175 was going to be the charge. He said we'll take care of that.

My doc is great! I didn't have to do any pissing contests like I did with crazy billing lady. He just understood right away what I was getting at and said he didn't want to make me unhappy (paraphrasing) and that I won't be charged the office visit from now on.

He left the office and the nurse was there and he told her, "We've got to change this," this being the way they advertise their fees. She said okay and that was that.

I feel so much better. It's great to stand up for yourself. I never thought I'd actually get anything out of it money-wise either. I think us "fatties" sometimes have a hard time doing this too - standing up for ourselves - and it feels great to learn these skills.

YAY Linda!!!!

I am so glad you brought it up to him!!! My DD told me all along, that the Dr's she worked for seldom had a clue what was going on in the front of the office, especially the one she worked for whose wife worked up front. She said they portrayed themselves as generous, Christian people, and in reality HE was, he donated time and service, and his wife hated it passionately, and overcharged, and billed insurance fraudulently--she was a witch my DD said!

I am so glad you get to stick with the Dr. you like. Good for you!!!!!!!

Take it easy on that new fill!!

Kat

UPDATE:

Great news! I told my doc about the 90 day thing and he said okay, I'll talk to Kay about it (crazy billing lady). Then I said well, actually, there's one more thing - and told him about the $53 office visit and how I was told $175 was going to be the charge. He said we'll take care of that.

My doc is great! I didn't have to do any pissing contests like I did with crazy billing lady. He just understood right away what I was getting at and said he didn't want to make me unhappy (paraphrasing) and that I won't be charged the office visit from now on.

He left the office and the nurse was there and he told her, "We've got to change this," this being the way they advertise their fees. She said okay and that was that.

I feel so much better. It's great to stand up for yourself. I never thought I'd actually get anything out of it money-wise either. I think us "fatties" sometimes have a hard time doing this too - standing up for ourselves - and it feels great to learn these skills.

im so glad your trip to the docters turned out well,and that your feeling happy and omfortable with your docter,some secretarys are hard to get along with[smile].

its great you had the confidence to say somthing,now it saves you worrying about it as well.good for you.im normaly shy when it comes to confrentation to.

Hey....so would you not go to Dr. Gibbs now??? I am going to his seminar on Friday....Would you recommend him as a doctor??? Has he done many lapbands?? How long does it take to recover? I am so nervous about this...

Thanks for any answers!!

Zipnqueen - sorry for taking so long to reply! I haven't been on this site for a while.

I really like Dr. Gibbs. I think he is a VERY competent surgeon. I had absolutely no complications. And in the beginning you think every twinge is a slip or your pouch is distended or whatever "complication" you're reading about on LBT that day, so I'd call and they always made me feel so much better. They just seemed so competent that I never felt anxiety after talking to the nurse.

But I would be VERY clear about what the price is. For example, I thought I was paying X for the surgery, then got a bill for blood work. I had to pay for the blood work. This was not discussed. I let that one go.

I don't think he's done many lapbands (but that could have changed since I had mine done), but he's done a heck of a lot of gastric bypass (which is a way harder surgery than bypass). I figure if they're excellent with bypass then they're gonna be good with the lapband.

The one I did not let go was the $175 fee for fills plus the $55 (or whatever it was) fee for the office visit. It stated very clearly on my forms I should be prepared to pay $175, no mention whatsoever of an office visit. I raised it and kept raising it with him directly until he agreed that I shouldn't have to pay it.

Now that they've "learned their lesson" I guess from me, I would assume they're going to put it very clearly in their forms exactly what people have to pay. The reason they gave me for this flub up was that they're used to insurance-paid people doing it, thus they don't really care what they're being charged because they're not paying out of pocket, whereas people who pay it out of pocket DO care and it matters very much what is actually written in the brochure.

Dr. Gibbs told his nurse that "we've got to change this" meaning the brochure they give out. So I'm just assuming they will change it to include the office visit fee. If you still want to pay that much, go ahead. I really, really like Dr. Gibbs. Like I said, he's very competent, but very busy (but then what doctor isn't).

Another thing I did not like was a LOT of info on the band I did not get from the seminar or the brochures I was given, but right here on LBT. I've come to realize most doctors give out waaaay more info than I got - but then again I didn't go to Dr. Gibbs' seminar, I went to his partner's seminar (can't remember his name right now).

I know Dr. Wellborn has free fills for, I don't know, 1.5 years, and then $100 thereafter (fills, including office fees all for $100), but I did NOT like that he wasn't in a hospital setting. I felt way more comfortable being in a hospital for my first ever surgery, in case something went wrong and they could hopefully "fix me" sooner than in a private clinic setting.

I understand your nervousness. I was a basket case and crying and shaking. Then they put something over your mouth to breath in and you don't remember a thing!

I would try to get a private room if I were you though. There was no end of interruptions due to the very old lady next to me through the day and night and I didn't get the rest that I should have.

I guess the thing is you have to be your own advocate. So make sure you nail down your prices, and make sure when you're in the hospital they're actually doing what they're supposed to - I had to insist on getting those leg bands which help circulation. I kept saying, "Aren't I supposed to have those leg thingies by now?" and they kept looking for them, and then forgetting about me, so then I had to keep asking ...

Any more questions? I think I've exhausted just about every avenue! haha Good luck on everything!

Linda