DrHekier

In our clinical practice we have seen that a lot of patients have a hiatal hernia and they don't even know about it. They might have had vague symptoms, such as occasional GERD or mild nausea from time to time, but were never diagnosed with a hiatal hernia. Most LapBand surgeons will closely look for a hiatal hernia in the first part of the surgery, and if you have one fix it at that time. Don't worry, it won't interfere with your surgery.

First of all, remember that one person's Cigna may be different than another. Having said that, in our practice, we have found that nearly all insurance companies go by the BMI at the time of the first evaluation by the bariatric surgeon, so you should be fine. Do the best you can on the 6 month program to lose all the weight you can. The healthier you are going into the surgery, the more likely you will have a speedy recovery and a safe outcome. Good luck!

Some potentially big news came out a couple of days ago. Lap Band now has its own CPT code from the AMA! As many of you know, the way a physician files for a service performed is by providing a CPT code to the insurance company. When a new service is 'invented' there is generally a several year lag period until a CPT code is assigned. Until that point the physician needs to use an 'unlisted procedure' code which has been the case until now for Lap Band. This creates problems for both the patient and the physician, since the insurance company can essentially say 'this procedure doesn't officially exist' and will assign any value to it that they wish, or just deny it. The new code is valid January 1, 2006 I am told. It is 43770. 43770 – Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components). In our practice we will probably have people who were denied coverage for the Lap Band being 'investigational' or 'experimental' refile with their insurance company January 1st. However, the new CPT code will probably not help those who have an outright exclusion for morbid obesity surgery on their policy.

Great! Thanks for the update! I don't understand the confusion and why our office is getting so many phone calls. We will give them the number you posted. The Internet is great! Thanks sarahbethlane :thumbup:

In the past few weeks our office in Texarkana has received multiple phone calls by patients in Arkansas who had a LAP-BAND® placed by Dr. Rex Luttrell. It appears that these patients are unable to get a hold of Dr. Luttrell and they indicate he may have moved his practice to an unknown location since the office staff can't answer to his whereabouts. I'm trying to save our staff multiple phone calls by posting this. In order to accept a new patient we would need to get a copy of your operative report and clinic visit notes to evaluate prior to accepting you as a patient. Thanks,

In your doctor's defense, in my experience Aetna is one of the worst payors for Lap Bands and we physicians never know what they will do. I once had to wait 9 months until I got paid by Aetna for a LAP-BAND®, and of course this was pre-authorized by them in the first place. My biller was calling them every few days for several months and getting nowhere. Only after I intervened and started calling every few days for a couple of weeks, did they relent and agree to pay. A lot of patients aren't aware of the hassles that the doctors office goes through to get paid. I don't know the specifics of your situation, and I admit I am biased, but I have to take the side of the doctor's office over the insurance company. Especially Aetna. Even when they say they pay, they might take many many many months. Most importantly, congrats on your impending LAP-BAND®!:smile2:

Thanks for taking action. The more I read about Blue Cross Blue Shield the more disgusted I am. The LA Times had an expose a few years ago detailing how BCBS employees are praised for dropping coverage for sick patients, people with diseases such as cancer, or pregnancy. Search for the term "rescission." It is their term for getting rid of policy holders that will require medical treatment soon.

Unfortunately if she has an exclusion it is almost impossible to overturn that. In desperate cases, I suggest seeking the services of an attorney advocate for weight loss surgery patients, Walter Lindstrom. Obesity Law and Advocacy Center Walter himself has undergone WLS.

Work with your doctor's office. Each policy is different. One person's BCBS of TX policy may have different requirements than another person's Regarding what might work: we once had a patient that lacked one year of her five year weight history as do you. We provided a picture of her that was taken during her "missing year" which showed that she was at a similar weight as noted on her doctors notes for the years before and after. Good luck!!

I wouldn't worry about it. It looks like someone submitted for approval for an infusion pump, which is not commonly used in Lap Band surgery and a nerve injection which is never used. This seems to have nothing to do with your surgery. Congrats!

Regrettably there is a surgeon from Little Rock that is still practicing Lap Band surgery that reportedly has lost privileges at multiple hospitals in Little Rock. I understand he has resorted to taking his patients out of Little Rock to a small hospital in a small town that has given him privileges.

We have a primary care physician we have trained to do fills in the Ft. Smith area. Let me check with him to see if he will fill patients that are not from our practice. The potential conflict lies in the fact that if you develop some sort of issue with your Band that would require that advice or intervention of a surgeon, he needs to make sure that you have a surgeon that would be able to see you. I will be out of town for a week so if I don't post a response or PM you, feel free to PM me as a reminder.

That doesn't sound right. Are your surgeon and hospitals certified as a provider for the Centers of Excellence? We've been doing Medicare Lap Bands for many years and this doesn't sound right.

This does not sound right. Here in Texas we have been doing the LapBand for over 5 years, and I have never heard of a 5 year dietary requirement. Many insurance providers require a physician guided documented 5 year weight history showing obesity, but not a 5 year physician supervised diet. Ask your customer service rep to give you the link to the clinical policy bulletin on obesity treatment on their website or for them to email it to you. Sounds like some miscommunication or misinformation.

With the new year comes new resolutions. Betty, Dr. Keilin, and I have worked very hard in the past month or so to come up with a plan for our new blog. We have the initial version up and running and encourage you to visit it. Our pledge this year to our patients and LapBand community is to provide regular tips and updates to help you with your journey to successful health. Please take a moment to take a look at it. This is the initial version and it may change in the future. The way it is set up now is that we have two featured posts that stay on the top of the front-page followed by four posts listed by date of entry. To view prior posts you can click on the category button on the top menu bar, or you can click on either the calendar or monthly archive button on the sidebar on the right. Questions and comments can be left on each blog post and we highly encourage you to do so. I have already received several spam comments in Russian from spam programs that prowl the Internet so we have instituted the following measures: Firstly, to read a comment you'll put in your name (which can be a fake name or your real name which ever you prefer) and an e-mail address to make it harder for the spam programs to fill out the form. Secondly we will moderate all comments which mean they need to be approved before they are posted to the blog so again we can insure that the comments aren't spam comments generated by some Spam program. Thirdly we will probably lock the post for comments after a couple of weeks. Since we will be posting a blog post nearly every day we won't be able to go back and look at all of them. In the near future we anticipate the following changes: Somewhere we want to have an open posting area so people can post general questions or topics of interest for everybody to see. We highly encourage guest bloggers which means that anyone who has anything interesting or inspirational to share with others we would love for you to officialy post it on our blog. We are trying to set up the blog to tie-in with e-mail alerts so that any time there is a new entry on the blog it will e-mail you. This of course is only with each user's specific permission. You'll have a chance either accept or decline this email option, we will not send you spam e-mail you don't want. We highly encourage you to actively participate in the blog and want to also encourage you to have your friends and families participate by reading the blog and commenting upon it. The more people we have participating and supporting each other the better we will all do. You can get to the blog directly it typing "blog.noscales.com" or by going to it from the home page of Lap Band Surgery Texarkana- Serving Oklahoma, Texas, Arkansas, Louisiana . Happy New Year!

Our practice was invited to a conference last year that had many of the top Lap Band surgeons in the world. Many if not most of us have our patients go on a low calorie diet before surgery to shrink the liver. It is more imporant in men, and in larger patients. Here is a link to some papers describing liver shrinkage in response to low calorie diet: SpringerLink - Journal Article The effect of a low-carbohydrate diet on the nonal...[surg Endosc. 2007] - PubMed Result Change in liver size and fat content after treatme...[Obes Surg. 2006] - PubMed Result

Every insurance company is different. Your Lap Band surgeon's office should be able to help you. They might know right off the bat what your insurance company requires specifically. Here in Texas, many require a prior weight loss program. For some that can include programs such as Weight Watchers or Jenny Craig, but others are more strict and want physician documented weight loss plans. If your local Lap Band surgeon's office isn't sure call the insurance company again and use our template found on our site Texas | Arkansas Lap Band Insurance information. Good luck

Check out the comments on our blog post at www.noscales.com/blog.html . It's on the post titled "Lap Band Questions"

Hello everyone, it's Dr Hekier. We've decided for the new year we want to get very active on our blog on our website and use it as an opportunity to answer your questions. I haven't been as active on this site in the past year as I used to be, and we are going to have all of our staff participate on our blog, myself and Dr. Keilin, Betty and the nurses, and Stacia and Tiffany to answer insurance questions. We are trying to work out a few computer issues and hope to get things on track by January 2009. Another thing we want to do is get everyone's email address so we can notify people of support group meetings in their area or any other timely topics. We want to know what topics you want us to address so leave a comment on the latest blog topic at our blog at Texas Lap Band Talk Please note that we generally cannot offer specific individual medical opinions or advice due to medico-legal reasons and privacy issues which is one reason I have been largely absent from this site. :frown: Also, we never want our patients to feel we are lurking or snooping around. That's why I tell everyone, use a fake name! :angry_smile:

We are trying to set up a conference call this week with a primary care physician in the Fort Smith, AR area who can do fills on our patients. We would also work on getting a support group set up there. We did recently start a support group in Nashville, AR which is a bit closer to you.

Regarding Fed BC/BS, as we said earlier, as long as your ducks are in a row, they should cover the procedure without any problems. I've personally met Dr Luttrell at a Lap Band conference last year and got to know him over several days. It was a pleasure to get to know him and he seems like a great guy. We're all cheering you joining the LapBand club! Congratulations on your upcoming surgery!

We hear this all the time :hurray:. My wife, Dr Rachael Keilin, likes to say there is always someone who is not supportive (usually a skinny husband :hurray:) who says "If the Lap Band just lets you eat less, why don't you skip the surgery and just eat less?..... Why don't you just stay on a liquid diet forever?" :cry_smile: Ridiculous nonsense. The Lap Band is meant to help you change your habits and be able to control your portion size to help you not only lose the weight, but keep it off! It's not meant to be a temporary fix for 2 weeks. Good luck, aligmamma (great name!) we'll see you soon. Don't forget everybody, we're trying to get the blog on the website more active. Visit the blog, add comments. Email us to suggest things to write about. By the way, Amy (the dietician) is going to try to get me the text of her presentation from the support group this past Monday and when I get it I'll put it up on the blog.

Fed BC/BS was brought up on another thread a few months ago. They do not require pre-certification which should make you extra careful that all your ducks are in a row. You'd hate to have surgery and then after the fact find out you didn't meet their requirements and have to pay out on your hospital bill and surgeon bill. Our office is very strict to make sure all requirements are met before we perform the surgery.

By the way, I talked to Amy a few days ago and she is working on getting me a copy of the topics she discussed at the last support group so that they could be posted on the blog.

OK, you guilted me into it.... Was working on a blog entry recently and just published it. Has to do with weight loss plateaus. Some people just seem to get stuck when they lose about 50% of their excess weight. Take a look at the blog at our website Lap Band Surgery Texarkana- Serving Oklahoma, Texas, Arkansas, Louisiana (that's www . noscales .com ; this website adds that title text.)