PJ333

thanks for the update jenn! I'm sorry you had a bad experience Hopefully everything will work out with the insurance. I'm still a bit far out for my eval. Things have been crazy over here. We've put an offer in on a house - close March 3rd. I was in the ER yesterday with a kidney stone. *ugh* Good news though.. I've had my 1st visit with Peggy - the nutritionist. Now, 3 weeks later - I've lost 10 pounds!

I'm just north of Houston, in the Woodlands Area. Although I previously posted here, I thought I'd kinda re-intro myself as it's been awhile since I did so. I plan on being a more active member :smile: I'm a 38 year old mother of a beautiful 8 month old baby girl. Having battled this beast of a thing called "weight" since childhood, the overwhelming desire to see my daughter grow up has truly renewed my spirit to draw on all resources to win! My husband is VERY supportive and we know that this will be a drastic change - for both of us. Now.. The GOOD news! After a very big let-down...I just want to jump for joy! Our new (as of Jan 08) insurance, BCBS-TX, Customer Service has assured me that Lap-Band is covered! Our previous carrier, Cigna - excluded the surgery. So it is with renewed hope that I'm going to my Dr. Thursday in hopes of getting the ball rolling. Having previously talked with my Dr. about the surgery, she recommended Dr. Spiegel or Dr. Wilkenfeld for the procedure. She also told me that Dr. Spiegel, although is great, (her mom used him) his office is rather like cattle through the shoot there (not very personal.) I'm looking into Dr. Wilkenfeld as an option as she said he is more personable and available to his patients. If anyone has had experience with Dr. Wilkenfeld, I would greatly appreciate hearing about it. PLEASE! I've also seen Dr. Spivak mentioned many times in the forums. Opinions are welcome! I also want to thank the creators, administrators, and members of this site for their hard work and member participation. From my browsing and lurking the past few months, I've learned so much and feel quite a bit more informed about the realities and expectations of this surgery and it's resulting lifestyle changes.

Thanks Tabatha!

Hiya Ara - I'm in the Houston area :tt1: First - Call the 1-800 # on the back of your insurance card and ask them if your particular policy covers the surgery. Just because you have BCBS-TX insurance unfortunately doesn't mean that your policy covers it. Just in case it does... Here's some info from the BCBS-TX website: http://medicalpolicy.hcsc.net/medicalpolicy be sure to scroll down and click "I agree" then on the next page in the search box type in "morbid obesity" - click GO. a there will be a link for "Surgery for Morbid Obesity" click on the link. This page gives all the parameters that must me met in order to be considered. It does require a 6 month medically (Doctor) supervised diet that includes a nutritionist and excercise program. I'm on day 1 :tongue: Good luck with your quest!

Thanks for the info jenn! I have my appt with Peggy Wednesday. My next appt with my GP is next week. I need to find out if I need to reschedule it because it will only have been 28 days between visits. Heaven forbid I don't want BCBS to reject me because my visit was 2 days shy of 30 days.

I'm using Peggy as well. I've left a msg for her to call me to set an appt. As soon as I get rolling with her I'll be set. As for the psych eval, If you could post the info I'd appreciate saving the $75! BCBS-TX req's the entire 6 month thing... you are so lucky to only have 3 months! We are out on 242 a few miles for now. Our house in TN sold.. so we're house hunting :rolleyes2: Hence.. watching the pennies!

Just an update: I went to my seminar Monday and have chased my tail all week to find a nutritionist that would be covered under our insurance. Alas, nutritionists are only covered for treatment of diabetes. I am not diabetic, so.... it's all self-pay. $75 a visit x 6 visits for the 6 month diets program. Good news though, this nutritionist also does an excercise program! There's also the Dr visits, which should total 7. 7 visits x $25 for the med supervised part. And there's the psych eval which I've not found out if it's covered or not, the Dr that was recommended is $175. So... total up front out of pocket before surgery = $800. I guess I wasn't expecting so much up front. It'll be worth it... I keep reminding myself!!! Has this been anyone else's experience? (Nutritionist not covered?)

Congrats on your success! Your story is encouraging to me! - 38 lbs in 3 months! WTG! I'm just starting my journey, myself. I'm going to a seminar tonight

Don't beat yourself up. I think I slew this dragon awhile back by reminding myself that the band is not the end all and be all of losing the weight. I still have to follow a healthy diet. I still have to exercise. The band is a tool. Cheating on a diet is not following the rules. I've not seen any rules that say you can't have a band. I've decided that the mentality of having a band is "cheating" is crazy. Just because someone else can eat a truckload of whatever they desire and not gain an ounce while another person can see the truck coming down the street and gain 20lbs is not a device that can be learned. If so, we'd all be able to eat a truckload and be Twiggy. Either your body works that way or it doesn't. I've not seen my scales stop at 150 lbs since I was 15 years old. If a band will help me get back toward that area of the scales. So be it. There should be no shame in wanting to improve your health, extend your life, and enjoy being alive. If someone else dosen't see that point of view, I have to wonder what their motive is for wanting you to not want to acheive your goals. It may be harsh but others may: - be jealous of your success - be angry that they can't do it themselves for whatever reason - be fearful that your personality will change after the weightloss - be fearful they will be left behind or left out of your life afterwards This sounds like to me it's the other people with the problem, not you. All you can do is reassure them and then do what is best for you. *stepping off soapbox* P.S. I think part of me needed to see this in writing myself

Congrats on your decision, Babs! I'm just starting the process, myself. I've found this community to be a wealth of information and support - Welcome to your new life!

Jenniferann6: Thanks for your offer.. I just might be ringing you up for pointers in this strange (but nice) new land of Texas! Glad to hear from someone else using Dr. Wilkenfeld. I'm going to his semminar this coming week. Is your insurance making you do the 6 month diet ..etc?

Congrats on getting your date! Concentrate on the end results... that is something worth being happy for sure!

minpinmom: Is the support group for Dr. Spiegel's patients only? Have you met with him yet? What were your impressions? on a side note: We have a 3 year old minpin all of about 7lbs. Rust and chocolate... like peanut butter and chocolate.. we call her Reese-Pup

LoL that would entail wearing a dress...and I am such a jeans and t-shirt kinda girl. I guess losing the weight might have me reconsider my wardrobe though

This is all encouraging news! I don't want to get my hopes up but man o man... it's tough! It sounds like it's all a game of "hurry up and wait!" Hey YoYo.. guess we're going to have to start wearing heels

JuliaF I sure hope that my prev attempts will be accepted! Thanks for the encouragement! (My hubby is former Air Force and is from Indiana... just a weird coincidence!)

I had my appt with my GP today. I took in all my paperwork that I had. They have yet to receive my records from my other Drs that were requested last week. I'm sure they are on their way though. My GP told me everything looked like it was in order and to go ahead and get registered for a seminar with a surgeon. I scheduled for a seminar next week with Dr. Wilkenfeld in Conroe. I've learned that they are moving their offices to the Woodlands/St. Luke's location at I-45 and 242 which will be very convenient for fills down the road. We'll see how the seminar goes. My BMI is 45.3 so the co-morbidities aren't an issue with my insurance. Just a side note: Weird... The nurse measured my height... I've shunk. I was 5'6" in high school (at least I thought I was!).. I'm down to 5'5" now... :huh2:

From what I've read and understand myself, the diet has to be doctor supervised with monthly weigh-ins at the office and a nutritionalist has to also be involved. Some insurance plans require 6 months - some 12 months... not every plan is the same. Some insurance plans except Weight Watchers/Jenny Craig. I would check with your plan for specifics. Call the customer service # for further explaination if you can find the info you need. Have them explain in detail exactly what they require!

I'm hoping that my dr records reflecting my med supervised attempts will pass - even though I did not do diet/excercise logs. I've also requested my OB records as well - All from Tennessee. We lived in the New Orleans area (Slidell) from 2002-2005. I've requested my GP & OB records records as well. I just hope they still exsist! Our BCBS has a $300 ded and we pay 20% of the cost after that up to a $3000 out of pocket cap. So I figure that We'll be looking at $3300 plus whatever co-pays we have beforehand at $25 each. Beats the crap out of $15k. I've bumped a thread about fills and the CPT code for that procedure. Does anyone know if they've created a code for the fills yet? I had read an older post from 2005 that stated they didn't have one yet. I'd like to know the code so that I can call BCBS to see if my policy covers the fills as well. Any info is much appreciated as always!

Wow! Who was your insurance carrier???

:bump: Anyone have codes for fills? I noticed this was originally posted a long time ago. Just curious so I can find out if BCBS will cover those after surgery as outpatient surgery or as a regular visit. I've read many senarios here and am just trying to get a fix on the reality. Thanks!

When we had found out that our previous insurance was not going to cover the prodedure, we had resigned ourselves to the fact that if I was to get this done it would be self-pay. I had never thought of going to Mexico. Logistically, with the baby..etc - it just wasn't going to be an option. We looked into self-pay options. You'll find that many surgeons offer discounts to self-pay patients. Maybe that would be an option if you want to stay local. We only moved to Texas a few months ago... so I'm very much still learning the lay of the land here! It's been a challenge as we don't know anyone here. Our house in TN sold at Thanksgiving and we'll be looking to buy another house in March. (Woodlands/Augusta Pines/Tomball area) I think 2008 will be another year of big changes... hopefully all for the better!!!!

Grats on the surgery! I've not gone to a seminar in TX yet, though I had previously attended one for The Cumberland Center for Obesity in Nashville (where we lived before.) As far as knowing if Dr. Wilkenfeld is a covered under my plan, I've only checked on the BCBS website and found that he is indeed a covered provider. I've not yet made a decision about a surgeon. Just looking at options. The only thing that I've verified thus far is that the procedure is not excluded by our policy :cool: *yea!* That is alot further than I got with Cigna in 07!!!

Great to hear from you! I called BCBS again today to ask a few more direct questions to ease my comfort in believing that his will definitely be covered. After being let down before I guess I'm having trouble in trusting that it's true! I verified that CPT code 43770 - Laparoscopic placement of an adjustable gastric band (Lap-Band) is indeed covered. I have history of a Dr. supervised weight loss plan within the past 24 months, however, from what I heard today from Dr. Wilkenfeld's office, it may not cut the mustard for BCBS. It did not involve a nutritionist nor a written food & exercise log. I was prescribed phentermine and glucophage and walked a mile 4x a week. (treadmill) *sigh* I did manage to lose 25 pounds! I dicontinued the diet plan when my husband and I decided to have a child. Needless to say that weightloss had been regained and then some since the pregnancy :cool: Anyone else have a Dr. supervised plan that did not have nutristionist & logs - and get approved????

JBare - I am in the Houston area as well and my insurance will be changing to BCBS in January. It looks as if we'll be in the same boat! I hope our new policies cover the procedure!