Jodi_620

At the first meeting, we received a packet that shows the price breakdown for insurance and for self-pay (self-pay with him is $17,500). Looking at the self-pay breakdown, the only two things that I see that were not included in the price are the Upper GI done at the hospital and the bloodwork/EKG done at my doctors office.

I don't see it as unethical. $1,200 is her fee but if the insurance company doesn't cover it then she gives the patient a break. My surgeon gives a discount to self-pay patients too.

I was told that I will have five.

Welcome Soldouthippie, Different insurance companies have different guidelines but generally you need to have either a BMI above 40 or a BMI of 35-40 with co-morbidities. Your BMI is 38.3.

I agree. Here in VA it is not as low as New Orleans but you would save about $8,000 just coming up here.

Depending on your surgeons schedule as soon as you get all of your pre-surgery things done (psych eval., nutrtionist, upper GI etc.) you should be able to schedule right away. I was going to get the surgery whether it was approved or not so I had already gotten most of my pre-surgery stuff done by the time the approval came (just needed the doctor's release and prepare for the two-week liquid diet). On the day the letter came, I called and they scheduled my surgery date right away. My approval came on the 9th and my surgery was scheduled that day for the 31st.

First of all- Congratualations! :thumbup: I wanted to thank you for a great post. It is a very informative surgery day play-by-play for people like me who are preparing to be banded and wondering what to expect. Hope you are continuing to feel good today!

Have you visited your doctor on a fairly regular basis over the past five years? They usually take your weight at each visit so they would have that in their records.

My surgeon has the psych right in his office. She charges $1200 but only asks $500 from the patient. She then bills the insurance company the full $1200. If they don't pay anything then she leaves it at that. If they do, she will return to me any money in excess of the $1200.

Are you on medications for pain or anything else? Many medications can cause this too.

My surgeon explained that any time we reduce what we eat or diet to lose weight the first place that the fat leaves the body is around the liver. There are different ideas about what kind of diet to follow whether it be low calorie, low fat, low carb, we are reducing what we eat thus reducing the fat around our liver. Since the liver is in front of the stomach, they move it out of the way and prop it up on a u-shaped stand that is shaped something like a two-pronged fork. A fatty liver will sag around this stand and could become bruised or damaged or get in the way of doing the surgery properly. The idea is for it to be firm and stay on the stand to avoid injury. I agree with wasabubblebut (BTW, love your user name:biggrin2:)the pre-op diet has less to do with recovery whereas the post-op if not followed correctly could really cause healing problems.

I wonder why he can't take care of it while he is in there, did he say? I have a slight hiatal hernia and although I haven't discussed this with my surgeon yet, the technician who found it during the barium swallow said that if necessary the doctor will probably take care of it while he's in there. In my initial consult, the surgeon mentioned that my gall bladder would be checked prior to surgery and any issues could be taken care during the surgery so I know that they can handle other issues while you are there...

Hmm, your process is a little different than mine. My medical clearance consists of me going to see my doctor and having him order pretty much all of the tests that you have already completed then submitting a letter of medical clearance. Since it looks like you have already had the tests, maybe he/she just wants to discuss your understanding of everything before writing the letter ???

I wish you the very best steffiegirl!

Congrats fotogurl. LOL, I had a similar reaction. When I saw the letter I thought it would be one of those "This is not a bill" statements from my barium swallow. When I saw that I had been approved I did a victory dance around the dining room table. My dog didn't know what the heck to make of it but he joined in anyway. :tongue2:

I will keep you in my prayers Melissa. I know what you are going through, I was on pins and needles while I was waiting to hear back from them.

I'm with United Healthcare. I needed the psych eval (which is standard with my surgeon anyway). Their requirement with no comorbidities is BMI above 40, I just made it with a 41. My surgeon submitted the required information and I was approved in about a week and a half.

They do this to make sure that you do not have any issues with your esophagus, stomach, and small intestine that would make you a poor candidate for the surgery. I have a slight hiatal hernia but the technician said that it wasn't bad enough to disqualify me for the surgery and that the surgeon might just push it down while he's in there. You are right though, it is not a pleasant test, the stuff they have you swallow is awful! :tongue2: I had to have: Barium Swallow (upper GI) Then Psych Eval Then Medical clearance from my doctor: CBC, Lipid prfile, TSH, EKG, PT/PTT, CMP with medical clearance letter (doing this today!)

I haven't had my surgery yet but this question was brought up to the receptionist at my surgeons office. My surgeon does all surgeries on Friday. She had the surgery and said that physically she felt well enough to work on Monday but was still pretty tired. She recommended that if you feel you are physically able to go back to work, plan to work half days on Monday and Tuesday and by Wednesday you should be back to your old self.

Congrats Kate...I know that excitement, I got my approval through UHC last Friday and I was dancing around the house. Best wishes!!!

For my first visit I was scheduled for 4-5 hours in which I had to take the Psyc Eval exam. It was something like 900 questions where you fill in the little dots for true and false. It was mind numbing for me, they asked questions like:Do you love your mother?, Would you like to be a florist? Have you ever stolen anything? Do you enjoy torturing small animals? :thumbup:... On the second visit she went over the results of the exam and told me what the results show and it was pretty accurate for me. Then we discussed what to expect before and after the surgery and specific hurdles I may have based on my evaluation. I also had to sign an agreement that if anytime after the surgery, my surgeon feels that I need to see her that I will do so. The second visit took about an hour.

Hi everyone! My name is Jodi, I have been lurking on this site for a month or so and finally decided to become a member. I am 38 yo female from Virginia. I have been going through the process of getting the lap band surgery for about a month now. I have done the psych eval, the barium swallow and the nutrition class. Just got a letter on Friday from my insurance company approving the surgery No questions asked, no hoops to jump through...nothing! I was pleasantly surprised by this because I am just within the guidlines for BMI (40) and I do not have any comorbid conditions (yet). I was prepared to be a self-pay if necessary but it turns out I will pay 20% out of pocket which is a huge relief. My surgery is scheduled for the 30th of this month and I am excited and nervous. I will start my Liquid Protein diet on the 16th. My surgeon requires two weeks liquid protien diet before, two weeks liquid Protein after, two weeks puree then slowly introduce solid. Just thought I would introduce myself.

Kim, I agree with the "one meal at a time" view, it is gonna be tough. I did all of my shopping over the weekend and have my liquid products all ready...four more days to get in all my favorite foods. :biggrin: Ashlee, I am in Northern Virginia near Dulles Airport. My surgeon is Dr. Eric Pinnar in Reston.