nursekathy2u

Yes that sounds right. Sometimes if I submit in the morning I get approval the same day. It will be quick for you!!

Hi, I do Bariatric surgery insurance approvals for a living. I work in the DFW area. BCBS Fed DOES NOT require a 6 month diet. They don't require psych eval, or nutrition appt either. When I submit to BCBS I always have the same nurse call me back for clinical info. She only asks current height, weight and BMI and any co-morbid conditions. They won't give you an approval ahead of time for outpatient surgery so we always do our Lap Bands inpatient for BCBS Fed patients so we can get the pre approval done. If you can get in to see someone and get them to get you submitted quickly you should be approved in just a few days. Good Luck! Kathy

Dr. David Kim in North Richland Hills is my doctor and he is wonderful. Cash price is $13,000. He has financing available. His video website is www.drdkim.net

How long did your port pain last after surgery? I had my surgery on Tuesday Aug 19th and it is still very sore today Aug 22nd. I'M starting to get discouraged and depressed.

Not always true.. sounds like she did not have an exclusion but was denied due to no co-morbidities that they accept. Sometimes it IS the insurance company... or in some cases the medical director. I do this for a living... Since the first of the year I have had such a hard time with one particular medical director at Cigna. He is VERY PICKY and in my opinion will deny people on technicalities.. An example... He denied a patient because he said they needed "medical clearance" for surgery. He would not accept a note written on a prescription pad from the PCP that said " Pt is cleared for Bariatirc Surgery from a medical standpoint". I use these ALL THE TIME. It is common practice for doctors to write notes on prescription pads in leiu of dictating a formal letter when the message is short. This man is just being unreasonable. I have had several denials from him this year.. I never got denials from Cigna before. They were always very easy to deal with in the past. I don't know if he is new or what. But he is a pain. If there is a denial from Cigna it always has his name on it. :redface:

You will get an injection of Heparin (blood thinning medication) in your abdomen prior to surgery. It is not a big shot. The needle is tiny but the medication does burn somewhat after you receive it.

I think you misread the last sentence. I think they are saying the word "treatment" doesnt mean surgical treatment is excluded, only medical treatment. What it says to me is that they do not pay for any medical treatment of morbid obesity including the things they require you to have done in order to get approved for surgery. It is very common for insurance companies not to cover anything to do with treatment of morbid obesity EXCEPT for surgery. If you want to be sure call your insurance company and ask them if Lap Band Surgery CPT code 43770 is covered. Good Luck! Kathy

I guess I am wierd. I actually enjoy tipping. However, I don't tip into tip jars. I tip the people who served me. If you want to feel good, stop a busboy and hand him 5 bucks. It will make his day!!! I always tip at least 20% and sometimes will leave $20.00 on a $40.00 tab. I think it is fun. It makes someone else feel special. And it makes me feel good to make someone else happy. For Christmas this year we gave the girl at the counter at the Dry Cleaners $100.00. She is a single Mom. Usually has her 2 boys on the floor doing their homework when I go by to pick up my cleaning. I never have to tell her my name and our clothes are always perfect. She was so overwhelmed with the gift. And it made Christmas more special for me and my husband to be able to give her this gift. I guess I figure I can't take money with me when I die. And unfortunately these days, monetary gifts often mean more than kind words, so..... Tipping it is. And beleive it or not I once had a college kid at On the Border refuse to accept a $20 tip I left for him. He was having a terrible time with a larger group and he neglected us. Other wait staff took care of our needs. The large group left him a 61 cent tip and he was obviously upset. My hubby and I felt bad for him and left him $20 and he chased us outside and refused to take it. He wouldn't accept a dime and actually appologized to us for the poor service. Their are good people out there, not just beggars.

My surgeon told me today that there are "documented cases" of "surgeons in Mexico" permforming lap band surgery for patients but only placing the port and not the lap Band. He says surgeons here in the states have found this when taking over patients that were done in Mexico. After several fills, when the patients had no restriction, did an upper GI and.... surprise.... no band!!! The saline was just squirting out into their tissues. This statement was backed up by 2 medical reps that are in the bariatric business. I have no other information than that.. No proof.. no names... just heresay really...Anyone else ever hear of this????

What insurance do you have? Who told you it was denied?? I have never heard of a behavior modification program.. I have heard of a diet, exercise and behavior modification program.. Something sounds wierd here to me.. there must be some more specific reason you were denied.

Hospital = $50 copay Surgeon = Insurance payment only, wrote off the rest Anesthesia = Insurance payment only, wrote off the rest Radiologist = $175

I wouldn't be surprised to find it happens other places besides Mexico. I have nothing against Mexican Surgeons or Mexico. I doubt it is widespread.. Im sure it is limited to one clinic... I was just appalled... WHY would anyone do this??? More discrimination against fat people?? Would they do breast implants without the implants? One thing I do know is that the band itself is expensive... I wonder if the discounted surgery prices that you see in Mexico and other places may be the motivation. Cheaper to buy a port than a band.. I just don't know

Tink.. Why did you get denied?? Maybe I can give you some tips... Many times people get denied due to the way their surgeon submitted the information. I see that all the time. Also, on the diets, most insurance companies won't deny you if you don't lose weight. Believe me.. very few people lose any weight on the diets. I think the insurance company wants to see that you are comitted to the surgery and able to stick to a follow up schedule since that will be required after surgery. I also think they use it as a cooling off period.. maybe if they make you wait you will change your mind. Then there is always the assumption that fat people are lazy. Maybe they figure they will never have to approve us because we are too lazy to go to the effort of doing the diet. (If you can't tell I think the diet requirement is bogus too.) I think you should be required to have been on diets in the past though.. Surgery should be used as a last resort, not a first one. You would be surprised how many men ask for bands when they have never tried to lose the weight before. And the thing that sucks is that they will lose more weight, faster than us women!!!!! With or without the band.

Amen to that!!

I disagre with the death penalty. Killing another person doesn't solve anything. It doesn't bring back the person who was murdered. It doesn't bring "closure" (IMHO) because the family and friends will still think about the victim and the murderer probably every day. It is only "vengence" or "revenge" as far as I am concerned. Besides that, the execution only makes more victims.. the loved ones of the executed. Maybe it is the nurse in me, but I always feel compassion for those about to be executed. And especially for their family. How awful it must be to know your loved one is about to die. Knowing the exact day and time they will die must be horrible. Never mind having to be there and watch it. It is just horrible. I should also clarify that I have never been affected by murder personally. I am friends with the father of Darrant Williams of the Denver Broncos who was murdered on Jan 1st but that is as close as I have been to it. I don't know what I would feel in my heart if anyone I loved was murdered. I might want to kill the murderer myself.. I just don't know...

Really??? Tell that to the NAACP, LULAC, anyone who has been sexually harassed or raped, tell a dead baby joke to a mother whose baby died, tell a joke about supporting the execution of fundamentalists christians to a christian who has known missionaries who were executed for their beliefs, tell a gay bashing joke to a father whose son was a victim of a hate crime. Come on... you don't really believe that??? But then maybe youre beliefs are that shallow. Huh??? But you just said....... Aren't we full of ourselves??? And in case you think I am calling you a liar I am not.. I am saying you talk out of both sides of your mouth. Spout off what ever makes you "right" and the other person "wrong" depending on the most recent discussion. Some people always have to be right. It is a sign of fear and insecurity most of the time. So... here you go... "Good Boy!!! You're so intelligent and funny and full of awareness and understanding... we all stand in awe of your awesomeness... Good boy!!!! Oh wait.... the smileys....:confused::eek::):success1::car:

I edited the previous post to exclude things I didnt want to comment on.... What is considered "poor mental health??" Who makes this determination?? I wonder if they stastics are based on phamaceutical sales for antidepressants?? IMHO, antidepressant medication is overly prescribed. You mention feeling tired and stressed out and BAM!!!! Your given an antidepressant.. The current popular Selective Seratonin Reuptake Inhibitors such as Paxil, Prozac, Zoloft, etc., have such horrible withdrawal side effects that many patients find themselves stuck on them for years and years. You have to wonder why they were made that way. The pharmaceutical companies are certainly profitting from this. "6.5% of homicide victims are under the age of 14 in Texas" doesnt say it is a parent that killed them. Seems like kids are involved in gangs younger and younger these days. If they aren't, their parent or sibling is and they get hit by stray bullets in a drive by shooting.. This stuff happens more than it should. I do believe many of the 6.4% are killed by a parent, but I stand by what I posted earlier. I think it is most often a child who has suffered abuse throughout their lives and finally a parent goes too far and kills them. These poor kids go unnoticed by the media because they died alone, instead of with their siblings, and because there were no arms severed or heads bashed in with rocks. Just another child killed.. Not gory enough to be worth much media attention. And to make matters worse the parents are charged with something rediculous like "injury to a child" or "involuntary manslaughter". Call it what it is... MURDER OF A CHILD.. and give them mandatory life in prison without parole.

I think another key thing to remember here is that all the women listed in the original post were eventually found not guilty by reason of insanity or too insane to stand trial. Women like this usually snap and kill their children rather than abuse them for years and years and eventually kill them on accident while beating them. However, it is these habitual child abusers who accidentally kill their children who go unnoticed by the media because it is just too common place. As a woman who was an abused child sometimes I used to wish they would just kill me rather than having to live in fear and shame everyday waiting for the next time.... It is a terrible thing for a child to grow up so scared of everything... And feeling like you deserve every beating you get... Makes for a well adjusted adult!!!!!!!!!!!!!

That drives me crazy!!!!!!!!!!!! My patients will go religiously, every month and talk to the doctors about their diet and exercise and when we get the notes all it says is "patient here for weight check" I finally created a form for the patients to take to their doctor visits for the doctor to document on and give to them right then. That way the patient sees exactly what was documented and can get it corrected. I also give my patients diet and exercise logs to fill out and they have a place for the physician signature at the bottom. If all else fails I submit the office visit notes with "weight check" written on it and the logs with the docs signature on them to prove it was discussed at the visit. Then I write a letter to the insurance company and ask them not to penalized the patient for poor record keeping onthe physicians part. They always get approved with the logs with the signature on it.

I responded to the highlighted areas above. She said she "created" 9 months of "visits" and her doctor signed off on them even though she had only seen him a few times. No where in that post does it say that the information was never submitted to the insurance company. I could only assume from the post that the records for 9 months worth of visits were submitted and she was approved without having to finish the 12 months. If that had been the case.. stated exactly as above.. that would have indeed been insurance fraud. After her clarification as to what the notes actually were.. even if they HAD been submitted to the insurance company it would not have been considered fraudulent. The first post was misleading, or perhaps I just interpreted it wrong. As to Faithmd's question of "why do I care?"... Why shouldn't I care?? I am in the business... it affects me and my profession when other healthcare practioners lower the standards by doing stupid things. From the previous post it gives the impression that physicians can be manipulated into doing unethical things... some can be manipulated.. and that pisses me off. I am also in the weight loss surgery business as well as being a patient. I had to do my time on a diet before I could get approved.. I had to jump through hoops to get approved, why shouldnt every one else have to follow "the rules"?? I have had a patient ask me to bill her insurance now for surgery but do the surgery the following month. She was quitting her job and didn't want to pay to COBRA her insurance. We have had a patient try to use her sisters insurance because she didn't have any. And don't even get me started on the folks who are on medicare disability and want the taxpayers to pay for their surgery but they can't even tell you what their disability is. I had another patient on medicaid who actually owns a business but put it in his dogs name so his profits wouldn't exclude him from medicaid eligibility. I understand about truly disabled people. Some people are so obese that they truely could not possibly work due to joint pain, back pain, shortness of breath, limited mobility etc. I am in no way making reference to anyone who TRULY is disabled. Im talking about folks who want a free ride..... Now I am on a soap box that has nothing to do with the original post!!! Anyway, as a weight loss surgery patient myself I understand how desperate people can get to have their surgery done. I was one of those people. I guess Im just a stickler for the rules.. If I have to follow them why doesnt everyone else??? Because life is just not fair I guess....

We are PRONE to killing our kids in Texas???? Good Lord what a statement!!! You have quoted 6 women out of the millions who live here.

Surprising to me that a physician would be willing to falsify medical records. Its against the law.... Especially knowing it may be turned in to insurance company... Not very smart.

Insurance Fraud

I am not friends with anyone on this board. I dont know you all and really have no desire to. I came here for support during a transition in my life. I just have a couple of things I would like to say. People who hide behind the Lord to chastise other people or use the Lord to make others feel guilty should be ashamed of themselves. HOW DARE YOU drag the Almighty God into this kind of bickering. Do you keep God on the same level as yourselves?? Keep Him on a leash and turn Him loose whenever it makes you look good?? I can't stand when pious people throw this "I will pray for you crap" around to make them seem holier than thou.. Just as bad are the people who use your christianity to slap you in the face. "I thought you were a Christian"... As if that is something they just came up with and haven't used that line time and time again to attack people. Christians are sinners, people. Jesus is the attonement for our sins. Paul, David and Moses were all murderers for God's sake and the Lord used each of these men in mighty ways. They each wrote major portions of the Bible. God created us to worship Him not to use Him for our own foolish gain. Come ONNNN!!!!! Enough if enough. Dont you all have friends in "real life"?? If your so unhappy online then step away from the keyboard... Shut the dang thing off... move on with your lives.. find another message board where everyone is perfect.. Or do SOMETHING!!!! But leave God out of your petty, childish bickering. If your not a Christian then be a decent human being and leave Him out anyway... He is very important to some people. My Advice to all the angry people: Get a grip and move on past it. Kathy

For those of you who use Dr. Sewell in Southlake, how often does he do fills?? Where do you get them done?? Does he do them himself or someone else?? Does insurance usually cover this?? If not, how much does it cost? Kathy