Randi

Happy2, Here's the link to the Medicare decision that's affectiing your ability to get fills: http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=160 Here's a link to the Medicare-approved Bariatric facilities: http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage

Diane, I'm going to piggyback on NJChick's great suggestion. If you're short on time and need it faster, you may want to consider investing in a pressure cooker.

MaryB, I've never heard of having to have 5 years of documented weight loss efforts. Although, I have read that the person must have been overweight for at least 5 years as part of the criteria for surgery and normally you're required to self-report the diets you've been on in the past. Maybe she misread or misunderstood the information she was given? If not, past visits to the doctor's office may prove helpful in her situation because the first thing they have you do is get on the scale. That tidbit right there may be enough to fill the requirement.

Here's a recipe I found in Yahoo BandsterRecipes group posted by Lisa Kaiser: White Chili PAM (original recipe uses 1 T olive oil) 4 skinless, boneless chicken breast halves - cubed 1 onion (chopped) 1 (4 oz) can diced green chiles 1 t garlic powder 1 t ground cumin 1/2 t dried oregano 1/2 t dried cilantro 1/8 t cayenne pepper 1 (15 oz) can cannellini Beans - drained & rinsed 2 green onions, chopped 2 ounces fat free shredded cheese (Monterey Jack or Cheddar) Spray PAM in the bottom of a sauce pan. Cook onion until transparent. Add chicken and cook until opague and juices no longer are pink. Add remaining items...cover and cook on low heat for about an hour (it's ok to cook longer). When done serve in bowls and top with cheese and chopped green oions.

Freebekie, The Wish Center is also out of network for me. However, the surgeon -- Rajashiwala is in network. I haven't quite figured that one out yet.

Dr.C, This would definitely be a GREAT post for the OH website. Hmmm, maybe in a few forums?

July5, I think Dr. Seger was the surgeon I met at the seminar I attended last year. If it's the same person, he was brand new to the group last June. Do you know the total number of lapbands surgeries he's performed since joining the group?

Yep, I'm waiting for insurance approval, but it's likely that I'll have to appeal. The insurance company I'm with readily approves RNY, but not the lapband. We'll see . . .

July5, I'm also in San Antonio. I started off with New Dimensions, but they're out of Network for me. Who did you decide to go with for your surgery in that group and how did you go about choosing your doc?

I attended a couple of seminars given by two different surgeons, then I chose Dr. Marquez. There are 11 surgeons in the group to choose from and you can read their bios on their website: http://www.swbariatricsurgeons.com/. You can also go out to www.obesityhelp.com and read what their patients have to say about their experiences with a particular surgeon, the staff, and the hospital.

I've also started the process with Southwest Bariatrics. Dr. Marquez is my surgeon. However, she's only done about 50 or so bands. You might want to call to find out how many bands the surgeon you select has done to ensure you're comfortable with him/her.

Em, I came across this appeals guide, which may prove helpful. Here's the link: http://www.lapband.com/lapband/documents/6.10%20HM0459%20Appeals%20Guide.pdf

RLittman, Check out this thread: http://www.lapbandtalk.com/showthread.php?t=19809

Funny, The thread got me to thinking about whether low bmi bandsters will have to consider apron removal. So, I started researching and came across the website, thought it was applicable to the thread, and posted it. However, I've been unable to locate the information that started my Quest. So, I posted in the Dr.C thread on LBT and asked him about low bmi bandsters and apron removal. From his reply, I'm left with the impression that when I get to goal and give my body time to adjust, that I may want to re-address apron removal at that time for aesthetic reasons. Knowing me though, I probably won't.

I hear ya Alexandra, but the cost of that fill leaves my mouth hanging open. :omg: I absolutely can not believe someone charges that much for a fill.

He sounds very controlling. She may find in the months to come that she's better off without him. For her sake, I hope that his piss poor attitude toward her improving her health is temporary.

Leenerbups, It's sounds like Medicare has come up with a new ploy to reduce their costs for at time and levy it on their insured. Go out to http://www.fillcentersusa.com/. Maybe you can find a location nearby to get a fill for waaaaaaaaayyyyyyyy less than $650. I would also ask the surgeon's office why their fills are priced so high, especially if you're a current patient. I would think $200 would be the max for a flouro fill.

Mona, You stated you have health problems, but for insurance purposes they have to be stated along the lines of comorbidities -- Hypertension, sleep Apnea (some insurance companies don't consider this one), arthritis, diabetes mellitus, gastroesophageal reflux disease (GERD), etc. Read the BC/BS policy with your OWN eyes to find out what constitutes "medically necessary." The BC/BS doc may be stating your case within policy guidelines, and depending on how stringent those guidelines are, the doc may be correct. Also, get a copy of EXACTLY what your doctor submitted to BC/BS. Then, find another doctor who can help you state your case within the policy guidelines to gain approval.

Dr. C, Have you come across any studies or do you have personal knowledge of low BMI lapband patients and the need for Panniculectomy after significant weight loss?

Hey, Folks, I'm came across this article while researching WLS and the Panniculetomy procedure and thought I'd add it FYI: http://onhealth.webmd.com/script/main/art.asp?articlekey=56448

Josette, 27 July is DH and my 22-year anniversary. So, I think it's a great day to be banded!

Thank you for the reply, Dr. C. It's great to have you in the forum for infomation and clarification.

Well, Folks, I'm still waiting to hear from Tricare, but my paperwork has made it past the local gatekeepers and was deferred to Humana for further review. So, hopefully, I'll get some type of updated status before the end of the coming week. We'll see . . .

DrC, I was diagnosed with bronchitis a couple of months ago and had a real bad cough. I just knew I was going to cough up my heart or a lung any minute and the Tessalon Pearls prescribed were absolutely no help at all. Anyway, I started thinking, "Man, I wonder what would have happened if I had the band." Would you shed some light on having the band with bronchitis or even the common cold would be problems that require immediate attention?

jjolive, Here's another idea I just came across on obesityhelp.com: http://www.clinicaltrials.gov/ct/show/NCT00247377?