Back~To~Amy

The CPT code for VSG is 43775. About insurance coverage, I've learned that just because you have a certain coverage, the benefits vary as the employers are selecting the benefits. I have BCBS OH but my bariatric coverage has little to do with that and much to do with what my employer selected.

That's awesome. Congrats!

Wow Denise! Congrats on the payoff of all your hard work! You rock girl!

Thanks Katenna. I had my fist office visit with Dr. nick yesterday and he told me I will hate him for about a week. :-)

Phillip- You need to call your insurance company. Speak to a supervisor if you have to. I have bariatric coverage on my policy. However, the benefits aren't very good so I too am doing cash pay. Because baratric surgery isn't an excluded condition, complications would be covered. If your policy has a bariatric exclusion, it could only exclude the surgery itself or it could exclude the surgery itself and and resulting complications. Best of luck to you!

Hi all. This is my first posting on these boards. I've been posting over on Lap Band Talks because I was 100% convinced I was going to do the lap band. Well, I went to the seminar tonight and now I'm leaning toward the sleeve. I still don't know for sure yet though. Anyone care to share their experience with the sleeve and if you are happy with your decision? Also, if you thought about lap band and went sleeve, what are your reasons? Thanks! ~Amy

What insurance do you have? I just called BCBS the other day and was assured any complications would be covered.

Band.....what band? I've 100% jumped ship over to the sleeve and cannot be more happy and confident with my decision. I'm at the beginning of the process but am moving along toward the ultimate goal.

Good luck!

I don't see what you see either. You look absolutely fabulous girl!

Thanks Mab. They don't require anything beyond 6 months proof of active participation in a non-surgical weight loss program. I'm not sure the billing records qualify as proof of "active participation" since just because I paid doesn't mean I went and actively participated. However, why would I continue to pay if I wasn't actively participating, right? Im just not sure the insurance company will see it that way. They will be getting my doctor records for the last year though because they want proof of other criteria such as my bmi and hypertension for the last year. My doc records will certainly verify my weight but not every week or month such as would be with Weight Watchers. I guess my main concern here is proving "active participation".

I have to submit proof that I was involved in a non-surgical weight management program for at least 6 consecutive months in the last year. I have already gotten proof from Weight Watchers of my payment for 6 consecutive months in 2011. What I don't have though is a record of my weight. I'm looking for some opions from anyone that has BCBS and had to submit similar proofs. Did you have to submit proof of your weight at each meeting or was record of your payment for 6 consecutive months enough? Thanks!

I'm about as out of shape as they come. Continue what you are doing. You will get farther and better as you loose weight and build endurance.

One of the criteria for insurance covering me is: The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery. Anyone know what do they mean by these efforts must be fully appraised by the physician requesting authorization? Thanks!

Weight Watchers is emailing me a list of the times I was on the monthly pass. Do you think I have to show proof of weight for each visit?

Emlefe----thank you , thank you, thank you for taking the time on your latest response and for the very detailed information you provided me. If my fees were to be similar to yours, it would still be cheaper for me to file insurance. However, you bring up a thought for me to check into. The cash price covers all follow up care (and I believe the nutritionist) for life. I'm pretty sure if you use insurance follow visits come at a cost. This year they would be free being that my sinus surgery should get me to my 2012 out of pocket maximum or very, very close to it. However, they would be free starting in 2013 so I would need to take that into consideration too. I'm definitely being careful and am going to make a mindful decision. As far as all the extras you paid for, I think that was a very wise decision on your part. Who knows if you will get dollar for dollar of your money's worth, but I think you were very smart in doing it. It looks like you got peace of mind in paying for the extras with your surgeon and that is certainly, as they say, worth it's weight in gold. Thanks again! I really do appreciate it. BTW, your profile pic is beautiful girl!

Thanks for all the advice and suggestions. Emlefe--I won't have to pay 50% of the total bill and it sounds like the prices you are giving me that the providers gave you are total charges and not the approved amount by the insurance company. At least, I hope so. Anyway, I only pay 50% of the amount approved by my insurance company and they reduce the total amount of the bill quite significantly. Like I said they are only giving an approved amount of about $2000 for charges of over $11,000 by my ENT. They did the same huge cut back on the facility charges too. I just don't remember what they were to post here. I'm hoping I have the same luck. BTW, If you don't mind me asking, how did you end up paying the majority of $6,000 to your surgeon if you only had to pay 10%? That would mean your insurance company's approved amount would have been nearly $60,000 thus making his total actual charges probably over $100,000. Thanks for the things to consider though especially about the other charges such as anesthetist, lab, etc. Lisa'sHope--yes, the facility is in network. 2bsmallagain-thanks for the advice. I will definitely have my i's dotted and t's crossed before I proceed with WLS. Cookies--Your comment about having complications covered by insurance is on my list of questions to ask. I believe though they will be covered. However, I am checking on it. fattymcfatterson--yes, 50% of approved amount is for bariatric surgery and yes, that is the amount for an in network provider. Other non-bariatric surgery is covered at 80% in network. I'm still waiting on the final word of my coverage from the "bariatric department" about my coverage. However, the manager at BCBS who is over our insurance company read right from our company's page about bariatric surgery and the information I've given is what I got from her. Also, I don't have an out of pocket maximum for bariatrics according to this supervisor. Here's hoping she was wrong and I have better coverage! However, I am prepared to pay the cash price if I have to. I AM GOING TO HAVE THIS SURERY....one way or another! Amanda-My doctor is actually the Medical Director over the WLS at the hospital on the Center of Excellence list. He doesn't have any ownership in the surgery center he uses. It is inside a full-fledged hospital but just not a hospital on the list. He uses it when possible to save on costs. Thus, passing the savings onto the patients. The other thing I love about him is if you pay cash, it is the total amount for EVERYTHING. All preop, surgery, hospital charges, other provider charges and all post of visits for the rest of your life. I will have to take that into consideration when deciding if insurance or cash pay is the best option for me.

Wow Modee. Your doctor gave you a lot better numbers than mine. My surgeon said 36% to 42% for lap band and 70% for the sleeve. From what I've seen on the lap band boards, I think their loss is somewhere in the middle of your doctor's statistics and mine. I've 100% decided now to go with the sleeve.

I thought I'd pass this along for anyone it might help. I was checking out Forest Park Medical Center because of an upcoming sinus surgery and got side tracked because of the bariatric surgery stuff on their site. Anyway, they offer band fills for $50.00. You can have surgery by any doctor and still use their services. All you have to do is make an appointment. They have several locations.

Glad it worked out for you chicasmom and glad you have low cost, high quality care at FP.

I think I heard protein pills have very little protein in then so you'd have to take a ton of them. I'm sure you can find info if you Google it.

You don't have to drink the protein shakes or do protein shots so long as you are getting your required amount of protein in which can be done with foods.

So I'm about the pickiest eater around. I have no problem whatsoever eating low fat. However, I have a HUGE problem eating and drinking low sugar and sugar free foods and drinks due to the sugar substitutes they use. I also cannot stand yogurt of any kind or cottage cheese...two foods I see mentioned a lot. I don't wanna give the impression that I don't want to work my future sleeve, BECAUSE I SO DO!!! But I just cannot do sugar substitutes of any kind. They literally make me gag! I don't have a problem adding a lot more Protein to my diet though. Just so long as it isn't in the form of something with sugar substitute. Is there anyone out there who eats a higher protein/low fat diet without so much focus on the carbs? As long as I'm concentrating on getting my protein (and liquids) in and staying within my calorie allotment, is that okay? I so don't want to fail at this, but I just can't live on a bunch of sugar substitute food and beverages! Thank in advance for any words of wisdom! ~Amy

Thanks Emlefe. I'm starting to feel better about being able to be successful without having to choke down sf stuff for the rest of my life. As far as drinks go, I'm good with plain 'ol water. I'm also a huge fan of unsweetened tea. I really don't need any of those other sf beverages. Oh, and try orange squeezed into your water if you like them. It is good and refreshing too.

I'm glad to see there is someone out there who feels the way I do. Another person answered a post and inadvertently kinda answered this one. She focuses on Protein and, although she looks at the carbs, she doesn't give them concern. I like that. Besides, I think by focusing on getting in the required protein with natural foods our carb count will naturally be somewhat lower. Heck, for me it will be a lot lower than what I eat now! I'm having a problem with Protein shakes too. I'm in the buying samples phase to try and find something I can stomach. So far, I've tried Slimfast and it was totally disgusting. I've also tried Chike and it was gross too. Not quite as bad as Slimfast, but still not good. I bought a small tub of some brand of Protein powder (can't remember the name) at the Vitamin Shoppe tonight to try but have yet to do it. Ugh! It is going to be a long wait to get past the protein powder stage! Thanks for your comments Amanda and congrats on your weight loss!