A lot less

I just saw his ad. I am sending my voice tomorrow. Congrats to you.

Did everyone get the email from Drs. H and K.? This is it. It is rather lengthy but informative. People, This is an urgent message about some unsettling news. Last week Wadley Regional Medical Center in Texarkana was informed by Blue Cross Blue Shield that they were immediately losing their Bariatric Center of Distinction designation, effective Friday February 26. They sent us this notification by email on Friday Feb 12 at 3:12 PM, I'm sure so we would have little time to respond to it. We have established and been designated a Blue Cross Blue Shield Bariatric Center of Distinction for several years and were stunned to hear this news. What was their reason? They said they only mean to certify centers that provide gastric bypass in addition to Lap Bands. They said that it was a mistake to certify us in the first place, and somehow they "overlooked" the fact that we did not perform gastric bypass for all these years. This is difficult to believe. When we applied for the the Center of Distinction we provided Blue Cross Blue Shield with all of our operative data which clearly shows that we perform Lap Bands only. This is a decision we have chosen voluntarily since the safety profile is so much higher with a Lap Band than with the gastric bypass which requires cutting and stapling the stomach and instestines. So they knew that up front. Additionally, every 3 months for the past few years, we have provided our data to Blue Cross Blue Shield, which clearly shows that we are not performing gastric bypass. What this means is that those patients who have a policy with Blue Cross that requires a Center of Distinction, which for our patients includes Blue Cross Texas TRS (for teachers), Blue Cross Illinois, and Anthem Blue Cross, they will lose the ability to have Lap Band surgery in Texarkana and have care in Texarkana for bariatric related procedures as of next Friday if the situation holds. The nearest Bariatric Centers for Distinction are in the Dallas area and Tyler area. There are none in the whole State of Arkansas and the closest in Louisiana is way down in southern Louisiana. I personally spent 3 days trying to reach someone who would listen to me. I was out of town when the message first arrived a week ago Friday, and when I got back to the office on Tuesday I immediately took action. I first called the Blue Cross Texas rep in Dallas, Celeste Stewart, but she said she had no say in the matter and gave me contact info for a rep in Chicago with Blue Cross Blue Shield, named Wendy Marinkovich. Ms. Marinkovich said I would need to talk to the Executive Medical Director, Dr. Carol Flamm, but refused to give me her phone number or email! On Tuesday, Ms. Marinkovich took my number and said Dr. Flamm would call me back. In the meantime someone not connected with Blue Cross gave me the number for Dr. Allan Chernov, the Medical Director for Texas. I called him and got his administrative assistant. They took down my name and number but I never heard from him. Wednesday, Thursday, and Friday, I made many phone calls and sent emails trying to reach someone. I still couldn't even get the contact info for the Executive Medical Director in Chicago, Dr. Carole Flamm, because they refused to get me her contact info. Luckily, on Friday I was able to find her phone number and email on the Internet. After leaving her a voice mail, and sending more emails to Ms. Stewart, Ms. Marinokivch, and Dr. Flamm asking that they please call me, I finally heard from Carole Flamm, MD at about 5:30 PM Friday. We had a lengthy conversation, but she essentially said there was nothing she would do, and the decision to remove our designation as a Center of Distinction would not be reversed. My personal opinion is that this is all a matter of Blue Cross Blue Shield trying to make more money, and keep their policy holders from getting the medical benefits they are entitled to. Here is a story I told Dr. Flamm which shows Blue Cross Blue Shield behavior of placing money over a patient's health: Back in 2007, my surgical partner, Dr. Keilin and I attended a conference entitled "Building & Managing Bariatric Surgery Centers of Excellence." One of the speakers was Dr. Michael-Anne Browne, at the time the Regional Medical Director for Network Medical Management for Blue Shield of California. On January 23, 2007, she spoke at the conference and she was asked about the difficulty in obtaining third party payor coverage for bariatric surgery. Her verbal response follows: "The problem with Bariatric Surgery is not that it doesn't work. We know it works. The problem is that it has expensive up-front costs. The average return on investment is 4 years. The average Blue Shield of California client switches providers in 2 to 3 years [to another third party payor.] Therefore for every patient we approve for bariatric surgery we create a better financial risk for our competitors." The point of the Regional Medical Director for Network Medical Management for Blue Shield of California was clear. Blue Shield of California will deny access to bariatric surgery to our clients for financial reasons, despite being aware of scientific medical evidence indicating that those patients' health will improve with access to those services. For those of you with Anthem Blue Cross, you might have heard in the news how the White House, the Dept. of Health and Human Services, and the House of Representatives Committee of Energy and Commerce are all investigating how it is that Anthem Blue Cross in California can justify their proposed rate hikes of 39% for policyholders, when their parent company had$2.7 billion in revenue in the last quarter of 2009 alone. For some background see:Anthem Blue Cross Internal Documents Here in our office, we provide our employees with Texas Blue Cross Blue Shield insurance. Each year we have seen our premiums skyrocket, and an annual rise in 20% is not uncommon. Yet the pay from Blue Cross Blue Shield, to us doctors as health care providers, has stayed the same or dropped most years. For those of you that have been with us for a few years, look at your EOBs. You will see we are generally making less each year for the same office visit. Or if you just had a Lap Band compare it with an EOB from someone who had one from a few years ago. We are making less each year. So where is this money from extra-premiums going? Not to pay health care providers, but rather to the profits of the insurance industry that is supposed to be giving you the medical care you pay for. Think about it. For those policy holders that are paying for a service, i.e. access to medically necessary procedures including weight-loss surgery when medically necessary, they are not being given access to those services. Sounds like thievery to me. Who does this affect? Directly it affects those policy holders mentioned above. But in reality it affects all of us. Because pretty soon, all flavors of Blue Cross Blue Shield may require surgery performed at a Center of Distinction. Also, what is to stop any other insurance company from sending an email at a late afternoon on Friday to a doctor or facility saying they can no longer provide a service to a patient? It is Lap Bands now, but it might breast cancer surgery, elective C-sections, spinal injections for back pain, or anything else in the future. We applaud consumer watch dog groups watching this issue: ConsumerWatchDog.org We must make a forceful stand now, which is why I am sending you this extraordinary message. The typical insurance rep probably rarely hears from a doctor or patient. Please take just a moment to leave a brief message or an email to the following people: Celeste Stewart Blue Cross Blue Shield of Texas Specialty Programs Manager 972-766-6829 celeste_stewart@bcbstx.com Dr. Carole Flamm Executive Medical Director Office of Clinical Affairs Blue Cross and Blue Shield Association 312-297-5905 Carole.FLAMM@bcbsa.com Dr. Allan Chernov Blue Cross Blue Shield of Texas Medical Director allan.chernov@bcbstx.com 972-766-1149 Wendy Marinnkovich Manager, Network Credentialing. BlueCross BlueShield Association wendy.marinkovich@bcbsa.com 312-297-6357 Additionally, I have another option I recommend. My brother is currently serving on the staff for the House of Representatives Subcommittee on Commerce, Trade, and Consumer Protection. It is the full committee, chaired by Rep. Waxman that is holding hearings on Anthem Blue Cross of California's exorbitant proposed rate increases. My brother pointed to me that Rep. Ralph Hall serves on one the subcommittees of that office. He serves on the Subcommittee on Health. Rep. Hall is the representative for many of us here in East Texas. A map of the district he serves is shown on this website: District 4 - Rep. Hall Please contact Rep. Hall on this urgent issue as well. The number for his Washington D.C. office is 202-225-6673. For those of you who think you have no dog in this fight, let me remind you that if abuses by insurance companies are left unchallenged they eventually will effect us all. Here in Texarkana many gynecologists no longer perform obstetrics and won't deliver babies because of insurance and malpractice issues. One of our neurosurgeons does not perform intracranial surgery anymore so if you have a head injury from an accident, or a ruptured intracranial aneurysm or similar brain injury on a day or night he is on call, you will quite possible die in the local ER while the Texarkana hospitals try to get you transported to another city to the care of an neurosurgeon. There are rumors of another prominent doctor in Texarkana that may drop Blue Cross altogether because of fights they are going through to get paid on surgical procedures they have performed over the past year. If you do nothing now, you might find yourself in the Emergency Room in the future needing care for a heart attack, stroke, appendicitis, or a whole host of problems, with no one to care for you. I urge you: contact the Blue Cross Blue Shield reps I have noted above. Contact Rep. Ralph Hall. Get the word out on Facebook, MySpace, Twitter, and any way you can. I will not give up. I hope you don't as well. Dr. Ron Hekier 2717 Summerhill Road Texarkana, TX 75503 To unsubscribe or change subscriber options visit: Subscribe/Unsubscribe/Change Options

I totally agree w/you about everything. I like Danny, but I want Rudy to win. I saw the youth minister when Danny came home and I thought they would have even acknowledged him, but they didn't. Was it my eyes but didn't Tara look a lil thick again?

yesterday coffee/protein mix B-oatmeal/protein mix S-crumbs of potato chips:mad: L-1 drumstick 1/2 c mac & cheese, frozen rice cake S-small fries:mad: D-1 drumstick,1/4 c beans, 1 Tsp. potato salad S-popcorn I have no excuse other than I need to do better.When I see the food even though I'm not hungry I just have to have it. It's me and not the band.

I don't like Liz either. I think that Rudy was full of BS and didn't have the balls to tell Becca that he wanted her gone because she was going to kick his butt. Liz is older and she can't play the game like Becca. I think that Rudy is doing very good losing his weight and he just might be getting a lil cocky about it. I like Allen, but I couldn't understand what he was talking about "playing the game" when he lost that challenge with the ropes, I would have thought he'd had that beat since he's a firefighter. Liz made me sick with all her whinning (secretly, I probably would have been whinning too:biggrin:).

:wub::biggrin::ohmy: That's a good one.

also try fish, it has a lot of protein, too. They say we should eat fish at least 3 x's a week anyway. I put some protein powder (whey vanilla) in my coffee (just a little) and use the rest in greek yogurt or my oatmeal when I eat it during the day.

I am having acid reflux at night and I just got a call from my dr's nurse about if I was too tight (I can eat solids so I'm not too tight) because of the acid reflux, she said for me to take pepsid (sp). I asked if maybe if the band was slipped she said if it had I would not be able to keep down anything even Water. I agree about calling the dr cause it might be you are too tight and you might need a unfill. Hope all goes well with you.

Just heard from the dr and his nurse said that if I'm able to eat solid food that it's probably from the spicy and tomato sauce. I've been eating much too late at night anyway, so when I stopped at 6 pm I slept better. I told her that my throat was still burning a little (from the acid) and she said that he said to get pepsid (sp) and go from there. I asked was that unusual and she said no, if I had a slipped band I would not be able to keep anything down even water.

I am glad I found this because I have been having this issue for about 2 weeks. I am now stressing. I didn't eat anything pass 6:00 pm and I slept fine last night. I had soup Friday and then that night ate some mexican food and was miserable. I ate meat loaf that saturday and was miserable cause I thought that it was the tomatos. I still have a slight burning in my throat, but I can still eat. I didn't think I was tight cause before I could eat very good. I have a fill 9/21. I did call my dr and they are suppose to call me back. I am so afraid until I can't think straight.

yesterday coffee /wprotein B-nothing L-greek yogurt w/protein D-protein shake

PB'd (Productive burp) DH (dear 0r darling husband) DS/DD (dear son, dear daughter)

yesterday coffee w/protein B-grits w/protein S-cheez-its L-2 chicken drumsticks, 1/2 c green beans S-cheez-its D-1 chicken wing, 1/4 c spinach

Where you been and how are you doing? Miss you in the Share what you eat post. Take care.

"And this this too shall pass..." That's why I come here to MAKE myself accountable. I need very much to get out the 170's too. Today IS a new day.

yesterday coffee w/protein B-1 boiled egg and 1 link S-15 fritos L-1 chicken thigh, 1/2 c green Beans S-12 p-nuts and too many cheez it D-3 bites of pork steak and 3 bites of green beans (slimmed) quit and went to bed.

I'm taking what DH is bringing from his job ( we don't Celebrate halloween) to work and the students are loving it. :thumbup: I still every once in a while take a piece. LOL

I agree. I was happy when they voted her off,:drool: but I've got to give it to her, the gurl:w00t: looks good. Who knows if she continues she might have a good chance winning.

Today coffee/ protein B-1 pkg oatmeal w/protein and 1 link S-12 fritos L-1 c frito pie D-wing and drumstick, 1/2 veggies (PB'd)

yesterday coffee w/protein B-1 c oatmeal w/protein, 4 pcs bacon L-1 c tuna (2 tsp light mayo) &crackers (Pb'd) S-1 midget tooties roll and 15 fritos D-1 slice of brisket, nibbled a bite of ham and two bites of cornbread dressing, 1/4 c veggies S-5 cheese puffs, 5 cookies I thought I did good until I saw this. The snacking will have to go. I can't continue to snack this much.

yesterday coffee w/protein B-1 sausage and 1 scrambled egg L- had lunch at church :scared2: dressing, ham, spoonful of english peas,1slice of candied yams, 1 slice of cake and a small slice of pie S-handful of p-nuts D- Brisket (2 small slices) and 1/2 c veggies, banana pudding I am not doing good, but back to the gym TODAY!!!!!!

yesterday coffee w/protein B-Jimmy Dean D'Light turkey/egg bowl S-fritos (darn things) L-leg quarter w/veggies S-2 p-nut butter crackers and popcorn D-1 hotdog w/o the bun I need to get a handle on my snacks. Today!!!!!!

yesterday coffee w/protein B- 4 oz Honey greek yogurt w/ the rest of protein from coffee S-fritos L- 1 drumstick and 1/2 c veggies S-2 handfuls p-nuts (PB'd) D- 1 c chili w/crackers S-2 p-nut butter crackers:cursing:

*****walking in like Hedi Klum (Project Runway) and saying "hullo"*******:thumbup:

I agree. Liz gets on my nerves, then maybe she and Tracey have become "best-est":confused: friends. Me, too