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PCP says he will refer me to a surgeon



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Good News! My Pcp is giving me a referral to a surgeon. I weighed in at 224.8 and bmi of 41. I'm nervous of course wondering what the surgeons requirements will be. But I am so excited to have made it past step one. Woohoo:w00t:!! I believe this means I am on my way to being a bandster. Wish me luck with the surgeon and the insurance. Does anyone have any advice for me at this point...like don't lose any weight til I see the surgeon? Stuff like that.

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that's what made me really look into lap-band....a few months ago my mom was at our PCP checking in (she had GB a few years ago and looks amazing) and when the PCP asked how I was, she told my mom that she already knows the new surgeon and is recommending me for the surgery. She thinks I'm a great candidate and referred me to start the process :tongue2: I'm excited and going to the seminar on 3/13...

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A lot depends on your insurance company's requirements. Some require that the surgery site be a "center of excellence" which means they have done x amount of surgeries (I am not sure of the whole criteria, but if they have the "center of excellence" label that is a plus). Many also require a documented 6 month (or two 3 month) diet attempt, and a BMI over 40 plus 100 pounds overweight, or a BMI of 35-39 with one or more comorbidity (ailments afftected by weight: diabetes, high blood pressure, high cholesterol, reflux/GERD, sleep apnea, joint arthritis and there may be a few others I can't think of). You will need to attend the bariatric seminar, have a consult with the surgeon, a psych evaluation (some may also want a stress test or echocardiogram), and when these are complete, your paperwork is submitted to the insurance company. I needed a 6 month diet so I just used the dietician on the bariatric team. Cost me $35 and I had to document my weight every other week, then at then end she wrote it up and I had to take it to my PCP to sign off. Once that was done my paperwork was sent. I am not-so-patiently waiting for approval. Hope this info helps.

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I do have co morbidities. Type II Diabetes, High blood pressure, High Cholesterol, Arthritis of the knee and years ago I was told I have mild sleep apnea. I am hoping for a good surgeon that has done many lap bands. We'll see who the PCP office refers me to. I will check out the surgeon once I have a name and ask many questions. Thanks for all your help.

Start/224.8/Goal/120

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oh yeah...all of that i already know...it's the same process basically as going for Gastric Bypass...the hospital team has been doing this for a LONG time...we just have a new surgeon to the area, that's all...thanks for the info though

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    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
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    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
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      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
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    • BeanitoDiego

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    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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