Randi

Dani, Before you withdraw the money from your 401K read this: http://www.smartmoney.com/debt/calculator/index.cfm?story=borrow401k Also, the beauty of the military health care professional in the Surgery clinic that does bariatric procedures, is that once you PCM refers you, there are no more questions asked. At that point, the only criteria is do you qualify and how soon can you get the prerequisite testing done (sleep study, mammogram, pap smear, echocardiogram, complete blood panel, etc.). How do I know? Well, before I discoved the lapband, I was actually pursuing the full blown gastric bypass at Wilford Hall Medical Center (WHMC). However, after I attended the information meeting with the surgeon and learned that the gastric bypass was a one way procedure, required lifetime supplementation because of the malabsorbption, and that the journey may be fraught with unrecoverable complications, I knew there had to be a better way. WHMC has been trying to get a their Ajustable Gastric Band (lapband) program up and running for well over a year, but just don't have the resources. So, that's why I've been exploring the other options available to me for payment. But, if the VA won't cover it and I can find an MTF that does the procedure, that's where I'm going. Self-pay is the last option I plan to pusue.

I just went out to the unjury site and guess what?! You can buy samples of all their flavors for 1.75 each! Yeah! https://www.unjury.com/ssl/purchasing.php

Has anyone used Profect (http://www.protica.com/profectsplash1.htm)? Also, has anyone tried getting product samples from unjury? I've tried Protein in both liquid an powder forms and don't want to waste money on a product I won't use.

DR. C, What are the CPT Codes used for fills with and without fluoro?

I'm considering self-paying for the lapband. However, I've read posts by lapbanders who had a hiatal hernia repaired during surgery. Are there any self-pay patients who unexpectedly had to have a hiatal hernia repair done during surgery? If so, was there an additional cost and how much? Did you have to pay it or did your insurance carrier pick up the bill for the hernia repair even though they wouldn't cover the actual lapband surgery?

That does sound like it's bordering on illegal. If that happens, you may want to file an appeal! BTW, your tag line is great!

I believe fills are billed under different CPT Codes and that fills with or without fluoro would carry two different CPT codes. You can ask your current doctor what CPT Codes he/she uses to bill for fills, then call Tricare to see if the fills are covered. Hopefully by next year Tricare will cover lapband and so it should follow that fills will also be covered.

GeezerSue, Have you tried the Protein you're linked to in your post. If so, I'd like to know how long you've been using it and what you think of the product.

Gael, Lapband is a trademark name used by it's maker -- INAMED. Officially, "lapband" as we refer to it here is called the Adjustable Gastric Band (CPT Code 43770). To learn more about the different types of weight loss surgeries to include vertical banded gastroplasty (VBG) visit: http://www.obesityhelp.com/forums/ and explore the "Surgery Type Forum." And . . . hold onto the "book of forms." You may need them to complete your next book . . .

Dani, I don't know what to tell ya. My husband seems to think Tricare may be covering lapband in some regions, but not in all. Or, the Tricare representative could be referring to the Gastric Bypass, which is a weight loss procedure covered by Tricare. So that would kinda explain the "covered, but it's not" response you received. If you can find a Military Treatment Facility (MTF) that is peforming lapband and that will accept you as a patient -- problem solved. Fortunately, Tricare doesn't care what procedures/surgery you have done at an MTF because it's no money out of their pockets. The only time Tricare coverage kicks in is when the procedure/surgery CAN'T be performed at an MTF and that's when the hoop jumping you're experiencing now begins. Good luck on getting written clarification. I suspect you'll be referred to Tricare Policy Manual 6010.54-M, Chapter 4, Section 13.2, Change 48 (dated September 8, 2006) which cleary states: DESCRIPTION Morbid obesity means the body weight is 100 pounds over ideal weight for height and bone structure, according to the most current Metropolitan Life Table, and such weight is in association with severe medical conditions known to have higher mortality rates in association with morbid obesity; or, the body weight is 200 percent or more of ideal weight for height and bone structure.<O:p</O:p <O:p</O:p POLICY<O:p</O:p A. Gastric bypass, gastric stapling or gastroplasty, to include vertical banded gastroplasty is covered when one of the following conditions is met: <O:p</O:p 1. The patient is 100 pounds over the ideal weight for height and bone structure and has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints.<O:p</O:p <O:p</O:p 2. The patient is 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.<O:p</O:p <O:p</O:p 3. The patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery (a takedown).<O:p</O:p <O:p</O:p B. In determining the ideal body weight for morbid obesity using the Metropolitan Life Table, contractors must apply 100 pounds (or 200%) to both the lower and higher end of the weight range. Payment will be allowed when beneficiaries meet all requirements for morbid obesity surgery including the ideal weight within the newly determined range.<O:p</O:p <O:p</O:p EXCLUSIONS<O:p</O:p A. Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction.<O:p</O:p <O:p</O:p B. Biliopancreatic bypass (jejunoileal bypass, Scopinaro procedure) for treatment of morbid obesity is unproven (CPT2 procedure code 43645, 43845, 43847 or 43633).<O:p</O:p <O:p</O:p C. Gastric bubble or balloon for treatment of morbid obesity is unproven.<O:p</O:p <O:p</O:p D. Gastric wrapping/gastric banding (CPT2 procedure code 43843) for treatment of morbid obesity is unproven.<O:p</O:p <O:p</O:p E. Unlisted CPT2 procedure codes 43659 (laparoscopy procedure, stomach); 43999 (open procedure, stomach); and 49329 (laparoscopy procedure, abdomen, peritoneum and omentum). EFFECTIVE DATE Laparoscopic surgical procedure for gastric bypass and gastric stapling (gastroplasty), including vertical banded gastroplasty are covered effective December 2, 2004.

Thanks, Ladies, This thread just-in-time! I was just researching yesterday how much time I would need off from work, whether I was eligible for FMLA, how much vacation and sick time I had, yadayadayada. Based on the input here, I think I'll request to be scheduled on a Thursday and take the next full week off. With the weekends, that will give me about 11 days (7 vacation days plus the 4 weekend days) off before I return work. I may also ask to work from home for 4 hours a day on the full week off so that my vacation time isn't greatly affected.

Dani, I called 1-800-444-5445 today. Told the representative that I wanted to check the coverage on a certain CPT Code. Gave her CPT Code 43770. She looked it up and said, "No, Adjustable Gastric Band is not covered." You may want to call the hospitals in your region to see if any of them are doing lapband implants. I know Walter Reed is doing them, but last I heard they were only accepting patients in their region.

I live near San Antonio, Texas and the cost range you mentioned is about the going rate for my area. The Wish Center here runs a self-pay special for $10.7K; Southwest Bariatrics in Austin is about 15K w/follow-up and fills, and New Dimensions is running about 15.3K as an outpatient w/out follow-up and fills and 20.3K with overnight stay and follow-up care to include fills.

Dani, I find it interesting that Tricare just disapproved my request for the band and now tell you that it's covered. This must be a very recent change. I think I'll call tomorrow to see if I get the same answer.

Thank you all for giving me another objective look at the band. Regardless of when I finally get my band, I know I've made the right decision for me.

I've actually joined weight watchers more times than I care to count. However I know it's a great program and I plan on following it once I'm banded.

Jobs? What kind of jobs? The only ones that immediately come to mind are protecting, greeting, fetching, playing, exercising, being loving, and possibly putting away their own toys. What other categories or subcategories of job are there?

I clipped out some member favorites from a previous protein drink thread. Unfortunately, I couldn't locate the thread, but here are the clips: "Nature's Best makes a carb free, clear drink that comes pre-bottled and in fruit flavores. Its called Zero Carb and from what I've read the Frosty Grape is the best." "New Whey Liquid Protein is like 4 oz of clear protein with 25 grams and it tastes like liquified jello @ only 100 calories. www.fitnessfirstUSA.com has them!" "My brand is called New Whey Liquid Protein and I get it from: http://www.wholesalesupplementstore....idprotein.html It tastes fine to me and is easier to get down than protein shakes." "...started with Carnation Instant breakfast mixed with milk and unflavored Unjury protein powder. I have tried a few since being banded (10/04) and now use GNC's whey protein in french vanilla - I mix it with oj, van yogurt & milk and it tastes like an orange julius, or I mix it with frozen strawberries/banana/milk and its kind of like a daquiri."

I clipped out some member favorites from a previous Protein drink thread. Unfortunately, I couldn't locate the thread, but here are the clips: "Nature's Best makes a carb free, clear drink that comes pre-bottled and in fruit flavores. Its called Zero Carb and from what I've read the Frosty Grape is the best." "New Whey liquid Protein is like 4 oz of clear protein with 25 grams and it tastes like liquified Jello @ only 100 calories. www.fitnessfirstUSA.com has them!" "My brand is called New Whey Liquid Protein and I get it from: http://www.wholesalesupplementstore....idprotein.html It tastes fine to me and is easier to get down than Protein shakes." "...started with Carnation Instant Breakfast mixed with milk and unflavored unjury Protein Powder. I have tried a few since being banded (10/04) and now use GNC's whey protein in french vanilla - I mix it with oj, van yogurt & milk and it tastes like an orange julius, or I mix it with frozen strawberries/banana/milk and its kind of like a daquiri."

I'm pre-band and it's good to know that the mental roller coaster ride is normal.

minpinmom, Tricare also authorized me four visits, but denied the surgery. However, my surgeon had already warned me that she had yet to see Tricare approve lapband and that her surgery group always peformed bypass surgery on Tricare insured patients.

Miper, I kinda had the experience you're speaking of. I went to a well-known surgery group here in San Antonio and was told they were no longer in the Tricare provider network, but they would accept what Tricare would pay as partial payment, but I would still have to pay $7,000 out of pocket. Because Tricare is an HMO (Health Managed Organization?), the key to using Tricare has always been to use their in-network providers, which means they have agreed to accept what Tricare will pay. This status can change at any time. So, always verify they are still in network before you use them in case the Tricare provider list is not updated.

Hey, Folks, I don't want to seem an alarmist, but I do want to give you some food for thought on Tricare: Yes, both Medicare and ChampVA now approve lapband. However, Medicare has added another hoop to jump. The facility where you have the surgery performed has to have the "Center of Excellence" designation or Medicare won't pay for the surgery or the fills. Now, I don't think it's too far of a stretch to assume that Tricare will add this as one of their additional hoops if they do start approving lapband. So, those of you waiting on Tricare to implement lapband as an approved surgical procedure may want to keep tabs on where the nearest Centers of Excellence are located. Here's a link to the current list: http://www.cms.hhs.gov/MedicareAppro...rder=ascending If there's currently not a Center of Excellence located near you, don't get discouraged. This list has grown substantially over the last few months and your facility just may not be listed yet. Just give 'em a call and ask where they are in receiving the designation.<!-- / message --><!-- sig -->

Well, Folks, as of last month Tricare is still saying "NO" to the adjustable gastric band (lapband), CPT Code 43770. So, I signed up for VA healthcare to see if I can get funded for the procedure. If that doesn't work, I'm going to research which military hospitals are doing the lapband implant to see if I can join one of their programs. As a last resort, I'll consider self-pay.

Hey, Pete, I see you posted. I just wanted to add a thread that goes along with your question. Enjoy! http://www.lapbandtalk.com/showthread.php?t=20217