Claytaco

These are the qualifications for lap-band surgery with UHC as I know them….. A benefit for bariatric surgery related to morbid obesity. BMI of 35-39.9 with two or more health problems associated with patient’s weight. Or BMI of 40-above without health problems associated with patient’s weight. 5 years of medical records (one medical encounter each year showing that your BMI is within range above). Some out of state or unusual plans can require fewer records. Diet and exercise for six months under the supervision of your doctor or bariatric clinic. Everything else you need, you get at your doctor’s office. --Clay WLIAZ Employee

Yes, if your surgeon's office can call for you that would be best. They will ask: Does this patient have the benefit for bariatric surgery related to morbid obesity? The procedure code for the band is 43770. They will then find out what the specific requirements are such as if you need diet and exercise and how many years of records (where your BMI was at least a 35) you need. Again, UHC criteria are highly standardized. --Clay WLIAZ Employee

Typically, UHC requires five years of medical records that show that your BMI has not gone below 35. PCOS certainly counts as a co-morbidity. The majority of UHC plans also require six months of diet and exercise under a physician’s supervision. I would call back or better yet have a professional call and verify the requirements with your plan. If your plan has liberal policies on authoritarian, jump on it. FYI: many of our patients with infertility often get pregnant in their first year. I thought you would find that reassuring to know that you are on the right path! I wish you well! --Clay WLIAZ Employee

You are welcome to come to our support group and see if it is something that you would like to be a part of. Our formal support group is getting rather full so we are trying to have it in other locations for our patients. Our informal groups that are patient led often have other patients that had their surgery from out of town but have joined our program for support. Good luck to you in your search. Best wishes, Clay

You are right, Tri-Care is great. I got to call all of the people that originally wanted the Band but were only covered for the gastric bypass. It was really nice to tell people the great news. It is impressive how great the coverage is. Things always change in the insurance world, but right now I think it's the best insurance you could have for the band. Congratulations! I wish you the best.

You’re right that fluoroscopy can be necessary to diagnose some complications of the band such as leaks or a port flip. Fluoroscopy is also helpful for someone learning to do lap band fills. However, it makes no sense to use fluoroscopy for routine fills. There is no need to expose the patient or the medical staff to radiation unless it’s necessary. Having ultrasound is helpful in routine fills because it’s quick and safe. If a suspected complication can’t be seen with an endoscope test or other means, then fluoroscopy is useful. Thanks for your comment.

The informal support group at WLIAZ meets on the second Sat of every month. The next one is April 12. You are welcome to come! Here is a link for future meetings: Weight loss institute of Arizona Have a wonderful day!

I would go to all of the seminars in town and find the best doctor and program for you. They are all different in what they offer for aftercare, surgery, and treatment. Everyone thinks their doctor is the best! I think that you need to spend time with the staff of each office to fully appreciate the differences. Because aftercare is essential to an effective weight loss program this should be an important part of your decision. Too often, people spend more time researching their TV than they do with their doctor. All local weight loss doctors in town offer seminars. Best of luck to you!

Having five years of medical history is essential with BCBS and most insurance companies. With any insurance company, it is black and white with coverage. With your BMI... you will have to show two medical problems associated with your weight. It looks like you have enough to do this. Your BMI can not have dropped below 35 in the past five years. If it has, the five years will start after you were back above 35. You have to have a benefit for bariatric surgery related to morbid obesity. Family history and logic have nothing to do with an insurance company’s approval of a LAP-BAND. It is unfortunate, but true. BCBS is actually a great company to work with because they don’t require a waiting period for diet and exercise supervised by a doctor.

Way to go! That day is coming up very fast. What are your plans for your next two months before the operation? Do you have any plans for anything before your date?

WLIAZ will see patients from Mexico. Many places will do fills on patients from Mexico but as far as I know we are the only ones that will see patient's that are having complications. I hope that helps. If there is anything I can do please let me know. I hope that you are doing well. --Clay

Dr DeBarros takes BCBS. Both doctors Dr Orris and Dr DeBarros will still work on your case. If there is any way you can contact me, I would be happy to speak with you about our program. How are you doing with everything? I hope that you are doing great. --Clay

At WLIAZ, Patients normally get their first fill about six weeks out. After that is based on how you feel and your weight is responding. If you are from New Mexico make sure that you tell the office this so they know that you can't reschedule. If you need any additional literature on band fills please let me know and I will make sure that you get them. I think that starting a NM support group would be a great idea. Maybe I can help with some of the planning. Thanks, Clay

I'm glad that you are doing so well now. Your progress is very impressive. Keep up the great work.

I think bands will still perform many years from now. This is because the band was built with the research of other medical implants. Bone replacements, plastic surgery implants, and other medical experiences have generated useful data that helped the designers of the band make a safe and inert device. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p> <o:p></o:p> Long term studies data would certainly be helpful but the short term studies are so good that it should give us all great hope.<o:p></o:p>

Hiatel hernias are often found on patients getting weight loss procedures. I've heard the doctors here say that they have to fix them every week on patients. They are often a source of pain and discomfort. I am sure that having your small hernia repaired now will prevent pain in the future. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p> <o:p></o:p> You should feel an improvement in your symptoms. <o:p></o:p> <o:p></o:p> How have you been doing? Do you feel better yet? I hope that you are feeling well.<o:p></o:p> <o:p></o:p> Best wishes,<o:p></o:p> Clay<o:p></o:p>

BC is a great insurance company to have but the most important thing to determine is if you have a bariatric benefit. If you don't have one, then any insurance company most likely wouldn't cover the procedure. If you have the benefit, with a BMI of 35-40 you have to show two medical problems associated with your weight. Also your weight for the past five years must not have gone below 35. With a BMI above 40 you don't have to show evidence of medical problems. I hope that helps. Best of luck to you!

I agree with kbinaz and TheGh0st above. Fills are something that are very simple and quick procedures but should be preformed by someone that is highly experienced. With the new small ports there is little room for error. The "poke and hope" method can easily cause a puncture of the tube which would cause a leak. Everybody wants to save money but since you've already invested so much of your time, energy, and money to get this far I would highly suggest sticking with your doctor or nurse that put in your band initially. I've seen people that have been "taught" how to do their own fills and it didn't turn out well. Be careful out there. There are many places that I am sure could help you and keep you safe. Best of luck to you!

Thanks so much for your response. We frequently get patients that, according to them, have been turned away from other clinics that will not treat the complications of their bands and gastric bypasses. There was never a time that WLIAZ did not admit patients with bands implanted at a foreign or out of state clinic. Normally, it is encouraged that patients retain the clinic that did their procedure for their band fills if possible. It is a huge risk to take over another person’s work. I think that is what you are referring to in regards to the past. You are correct that a few people will do fills on bands of other doctors. I was too harsh in my comment.

We do fills and treatment for weight loss surgery patients that had their operation at other clinics. As far as I know we are the only facility in Arizona or NM that will provide medical assistance for patients having weight loss surgery complications that had their operations at other clinics. For fills, there are some other places that you could go to. We regularly get patients having complications from their Mexican bands and from people that have moved to Arizona after their operation. We are used to getting patients that come to use from other countries and states for their operation. We try diligently to work with your schedule so that you can maximize your visits. If there is anything that I can help with, please let me know. www.wliaz.com

Hi, I would be happy to explain the insurance process with the band. There are two crucial factors for getting an insurance company to pay for you band. These two things are your baratric benefit and an acceptable BMI. If you do not have these two things, then you are a cash patient. After proving that your policy (not just your insurance company) has a baratric benefit, then you can look at your weight history. At this date, an insurance company wants to see five years of medical records that show that your BMI has been at least 40. Anytime that you went in for a check up, your weight was taken and there is your BMI. An insurance company will also consider your case if you have a BMI of 35 or above if you can prove two medical problems associated with your weight during the past five years. If your weight went below these levels, it will be at least a red flag and most likely a denial. I'd be happy to run your information to see if you would qualify with our program. I hope that helps, Clay

I am happy that you had a great experience. I didn't know that insurance would pay for a Mexican band. I'm glad that you are doing so well! Keep up the great work with your weight loss success, Snowbird!

I noticed that you were thinking about going to Mexico for your band. I know lots of people have a great experience there and save lots of money. If there are no complications, it is a great deal. But have you thought about what happens if there is a complication? Do you think that an insurance company would cover the expenses for complications of a foreign installed medical device? From my experience from working at a weight loss clinic, I would say most likely not. I’m all for going to Mexico. God knows I am crazy about Tijuana tacos! My dad had major dental surgery there and so forth and it was satisfactory I guess. The thing is that if you want to save money somewhere, why go el cheapo (if you will) with your body? Take the time to save up the extra money so you have the insurance that someone will be able to take care of you that isn’t a three hour drive across the boarder. By the way, I work at a place that sees patients that does work on people with foreign bands and they come in at least every couple weeks. Granted I only hear about the bad examples and not the people that have had good experiences in Mexico. Nevertheless, based on the examples that I’ve seen, there is no way I would allow anyone in my family to get their band outside of the US.

Good for you for being so quick! I will keep my fingers crossed! I hope that you are all right. Dr. Orris is a great doctor. I am sure that you'll be feeling better soon. Let me know how you do! --Clay

For fills of a non-local band Fill Centers USA or WLIAZ will do it. For work on band complications in Arizona, WLIAZ is the only place that will do it that I know of. They see Mexican banded patients that are having complications on a weekly basis. You’ll have to join their support program and have an initial evaluation. I hope that helps. If there is anything else I can do please let me know.