APRPro4U

OK, this is ridiculous. As of January 1, I will have Anthem BCBS -- a huge improvement over Tricare Prime. I think I can wait until then. I am exercising and treating my body better by eating more fresh foods and watching portions size. But THIS news shocked me today. Dr. Keshishian of Glendale, CA charges a $4,000 "program fee" to patients. I am disgusted. He is considered one of the best and yet he is involved in a practice that insurance companies find unethical and grounds for dropping him from their insurance policies. Have all of you paid these fees? This link shows all the insurance carriers he takes: http://www.obesityhelp.com/profiles/bariatric-surgeon/dr-ara-keshishian/#profile_insurance Now I know why. If he accepts all those, he can then collect $4,000 from each of patient -- on top of what each insurance company pays. I genuinely feel this is discrimination against the obese. Cardiac and Cancer patients are not charged fees in addition to what insurance pays. Why us? Because of my media contacts (I'm in PR), I am ready to write a press release, distribute it and see how the doctors feel when this info is public. I know the insurance companies do not support doctors charging fees beyond what is covered in the policy. This has to stop or people will die because they don't have the money. It's a tight economy and paying $4K just to get heatlthy seems wrong. Am I missing something? Thanks in advance for your constructive answers. M

You are all awesome. So here's the 64,000 question: How do I find a D/S surgeon who doesn't charge a fee? I'm damn good at researching anything & everything on the web but many -- like the doctor I was planning to see -- do not mention the program fees on their sites NOR their initial phone conversations. I don't need the "TOP GUY"...just one who knows what he or she is doing. Any thoughts? Again, thank you for your kindness. M

So I must share with you.... Thank you for all your kind words of support. I am grateful. Let me also say when I posted the same message on ObesityHelp, I was attacked by every person who responded. I ultimately deactivated my profile. As it turns out, I will likely need a D/S (duodenal switch) and not a lapband (too long a story) because I have 9 yrs ago I had a lap gastric bypass. But at the end of the day, charging these BS fees to morbidly obese patients who have insurance just seems wrong. Again, I am so happy you are so supportive. M

There is nothing worse than getting an email from someone who is uninformed and REALLY negative: You Can't Not Covered You Screwed up This is NOT aimed at anyone in particular, but I feel like I want to address it. The site should be a support site where people share experiences. In therapy, they teach people to say "I feel....."...."In my experience....." When you start with the words "He can't"...blah blah blah....you are killing someone's dreams in that moment. Do you realize how bad that feels to someone who isn't STRONG like me? Some of what I have read borders on cyber-bullying/abuse and is really ridiculous. We're adults! So at least if you are chatting with me, show me your data with links if you are going to speak in absolutes. I'm a very factual person who doesn't take well to anecdotal research. I like studies that involved hundreds to thousands of people. So again, thank you to ALL of you who have answered me -- regardless of whether I agree with you or not. But let's be decent to each other and think before we type. Oh, did I mention I am a non-denominational minister? Peace. M

NEED YOUR INPUT MY FRIENDS! Hello Friends I had my consultation with a pretty well known and 5 star rated dr. today in Orange County, CA. Here's what occurred: 1. Although I am 238 lbs at 5'2, he thought I should just do Protein shakes? Huh? He also talked about the fact that my insurance only pays him around $900 for the surgery. Is this something I need to know? I think not. 2. I had a RY lap gastric bypass 9 yrs ago. He said there is no way to redo a gastric bypass NOR have a gastric sleeve. Is this true? 3. He said I will only lose around 25 lbs with a lap band. Is this possible? If so, why? He has no tests yet as he ordered them today after we met. He didn't ask about my gall bladder either. I have Tri Care Prime so my choices are limited. So what do you think of all this AND can you recommend an Orange County, CA bariatric surgeon who takes TriCare Prime? Thank you all!! APR

So I have been taking all of your words to heart....Absorbing....listening...thinking. I decided to go to Dr. Keshishian's website at around 7:30 pm last night...I kept reading about revisions and his name kept coming up. I filled out the form on his site...including the copies of my insurance card and writing about my experience...my sense of failure. It's unfortunate that there is a lot of negativity when it comes to a person asking about a second surgical procedure..... At 7:50 pm -- on a Sunday night -- my phone rang. Guess who? Dr. Keshishian himself. I cried. He asked why I was crying....I told him that I felt like a failure but had also heard he is one of the best at revisions. He told me "It's not your fault"....explained the statistics and gave me more hope that I could ever imagined. We talked for about 15 minutes and he then said I would hear from someone in his ofc in a couple of days. If this is ANY indication of what kind of man Dr. K is -- and if I am blessed to get a surgery approved by TriCare -- I will get my life back. So instead of "no", "you can't", "it's your fault", the information I received from one of the top revision doctors in the country was positive, caring and factual. Soo.... Never say never...Always have hope and do not go quietly into the good night. I've annoyed a lot of people in my life by me being an overachiever...and this will be no different. I will bust my butt to make it happen and stay with it. God bless those of you who gave me his name. He is less than 45 miles from my home so I can go there easily. Fingers crossed. May all your dreams come true. M

Hi Vic, Thx for your input. It is genuinely appreciated. The reason I mention my education & successes is because many doctors (and some other professionals) talk down to obese patients. There is SOME TIMES (this is not an overarching statement) a sense that fat = stupid. We all know that is not true. With my JD, I am at least as educated as my -- no longer -- doctor so being honest and explaining his lack of expertise with revisions would have been accepted had he been forthright. My insurance will pay for a revision because there seems to be at least two indicators that there was a problem with the original. Further, the insurance I have now was not the one I had 9 years ago. Regarding ethics, while my former doctor might have some, I will be reporting him tomorrow to TriCare Prime. He is NOT allowed to ask for $500 to $3,500 in addition to the fee the insurance gives him for the surgery. That IS unethical and against the guidelines of many insurance policies. Second, I pride myself on my soft skills and I would NEVER talk to a client about my financial issues. It's simply inappropriate. If he is not getting enough from TriCare or other insurance companies, he shouldn't accept them. That's a simple business decision. I continue to enjoy the give and take of information here even when I disagree. This is truly social media at its best. M

Jack, Thx for your input. I am learning a lot and being reminded of issues I have not thought about in years. Because I have an MBA and a JD, I am used to discussing money, financial models, etc. with colleagues. That said, I don't think a heart surgeon would talk to a patient about how little he is getting paid for a bypass, stint, etc. Why are bariatric patients different? IMHO, I think the obese are still discriminated against by doctors and insurers....many of whom are also obese. I know from complexity. I just know something is not right with the gastric bypass I had too. I haven't mentioned this before but a couple years ago, I was gulping (I know, it was stupid) Water and I felt a pop....In my head I wondered if the staple or surgical glue came undone. I didn't go to the doctor. Further, before my knee injury and multiple knee surgeries, I was able to run 5 mile a day.....my current amt of activity because of all that has been greatly reduced. And I LOVE to work out! I have no doubt that I will find a solution but genuinely appreciate the input. Thank you.

Hello Friends I had my consultation with a pretty well known and 5 star rated dr. today in Orange County, CA. Here's what occurred: 1. Although I am 238 lbs at 5'2, he thought I should just do Protein shakes? Huh? He also talked about the fact that my insurance only pays him around $900 for the surgery. Is this something I need to know? I think not. 2. I had a RY lap gastric bypass 9 yrs ago. He said there is no way to redo a gastric bypass NOR have a gastric sleeve. Is this true? 3. He said I will only lose around 25 lbs with a lap band. Is this possible? If so, why? He has no tests yet as he ordered them today after we met. He didn't ask about my gall bladder either. I have Tri Care Prime so my choices are limited. So what do you think of all this AND can you recommend an Orange County, CA bariatric surgeon who takes TriCare Prime? Thank you all!! APR

Hi Melinda! To know me is to know I am incredibly positive, happy, driven, successful and RELENTLESS. I hold a law degree and have been an executive at 4 Fortune 500 companies. I have an awesome husband and live in paradise. Since my first post on the site today, I found not one but TWO doctors who specialize in revisions of all kinds. It is covered by my insurance AND I have learned it is more complicated and I am VERY OK with that. I weigh risk and reward...and take it seriously. It could indeed be a life and death decision... My weight was off for six years before i tore my PCL....and then endured multiple knee surgeries. And, so long as I am putting a lot out there, I can tell you I was in therapy and my therapist said I really didn't need to be there. I'm blessed. Also, I'm at that menopausal age....so I got that goin' for me too! Anyway, I appreciate honest, positive, informed input. Thank you all so much. APR

So what do you think my choices are? My understanding is there are revision specialists out there. I have heard of multiple people having more than one gastric bypass. Also, don't you think it's inappropriate for a doctor to discuss his relationship with insurance companies? BTW, I DID follow the program and was successful for 6 yrs. There is more to the story that I prefer not to discuss here. Thank you! APR

I have my appt with a bariatric surgeon with a doctor in Orange, Ca on Friday. But even if insurance covers it, there is a cash fee of $3,500 that is NOT covered by insurance. Is this normal? I wonder if my insurance company knows. It just sounds wrong. APR

Bob! Thanks for your note. Best wishes for a non eventful surgery. Look forward to hearing about your success afterward. xo APR

Greetings All! So the good news is I am seeing a very good bariatric surgeon on Friday. My primary made the referral and Tricare Prime approved my visit to the surgeon. On Friday, I will do the psych eval and see a nutritionist. To my surprise when studying the doctor's site I saw there is a $3,500 fee NOT covered by insurance. Is this new??? The whole idea of having insurance covered surgery is to have little out of pocket. I run my own small company and I have no clue where I will get that money from. Is it me or does this seem like double dipping (from the insurance company AND the patient)? My credit isn't great due to tough business conditions and the loss of a home in NV. Now I wonder if I will ever be able to get my surgery. HELP! APR

You are all awesome. I called TriCare *Prime" and I am locked & loaded for my consult / psych eval / nutritional eval on Friday with nothing due except a co-payment! Thank you for all your support. You all rock! Can you tell me the most important thing I should know about life AFTER lapband? I just don't want to ever gain all this weight back again. Thx. APR

Melinda Thx so very much for your response. I was SHOCKED when I read deep into the doctors website about the $3500. Part of the challenge is my insurance: TriCare prime. There are very few doctors who accept it to begin with.....but it was TriCare that found this doctor to begin with. I guess I'll be on the phone with them shortly. Any advice anyone could provide on an Orange County, CA doctor who takes TriCare Prime would be awesome. Thanks again Melinda!! APR

Good Morning New Friends, I am so grateful to have found this forum! I am a 50 year old relatively healthy married female. Nine years ago I had lap gastric bypass. When I began my journey there, I was 274 lbs and a size 22 about to be a size 24. I got down to a size 10-ish (I really am big boned!) Anyway, I find myself at size 16 and I really loathe my body....I am ready for lap band because I see the results seem FAR better than what I got out of gastric bypass. I don't know what I am more disappointed in...me or the procedure. I gained a TON of weight after I had knee surgery and the doc told me to basically sit down and be hold. I got FAT. Then I needed a 2nd surgery and was "grounded" again....but he told me it was OK to exercise...so I am slowly coming back....but the 40+ weight gain is brutal. In the past, I did Lindora, Weight Watcher, Alli, all that stuff. No long term results. Anyway, I have different insurance now and live in a different city. I am in Huntington Beach, CA and have an *** (Blech!) which is Tri Care Prime. I am scheduled to go to my new primary on 6/20. I come from people who die in their 50's from heart disease complicated by type II diabetes. I do want to be one of those. I don't smoke, I work out 4 days a week...I eat fresh fruits & veggies and little red weight. I take a bunch of supplements but not on any meds. My questions to my new lap band friends: 1. What do I need to tell my new primary about lap band. I am determined to get it approved but your input will help me fast track it as much as possible 2. Are there certain Tri-Care Prime doctors in the OC who are likely to help a patient get lap band? 3. What's the difference between lap band and o-band? Is one better than the other? 4. Who are the best surgeons for this procedure? I genuinely look forward to all your informed input and advice. Thank you. APRPro4U

Grandy, Thanks for your input. It is very much appreciated. If I had experienced what you did, I would have gone back to my surgeon. Your story is not uncommon. The people I have known had to go back to their doctors for adjustments and ultimately were successful. If I could do this without surgery, I would. I did Atkins and didn't lose a pound. My body refused to lose the weight. I have been on multiple "medical" weight loss programs to no avail. It stinks....so surgery is in my future. Thanks for your kind words. Stay tuned to see how this journey turns out. M

Hello Everyone, It's been a life of ups and downs with weight...diets, pills, etc. I'm tired of this crap! Can you recommend a doctor in Orange County (Huntington Beach, Fountain Valley, Newport Beach, Santa Ana & surrounding areas) who can truly help me? What's worse is my insurance is Tri-Care Prime. ANYTHING you can do to help is appreciated. Thanks and hope to chat soon. M.A.