Texarkana Bandsters

[hippmom 2]

l2 sorry to hear you are having to go through all of this!!! hope the next test comes out in a good way for you!!!!!

[Sugarbear 2]

Good morning everyone. Seems like I was getting back in the posting groove and then whammo....All heck breaks loose at my house. My mil fell and broke her hip and my son got sick too. Had them both in the hospital at the same time. He's better and we are still working on that aspect for her. She is now in rehab hospital. So getting to the computer has been far and between. Hope everyone is doing ok. I am hanging around the same weight, maybe down a pound or two. Got to get more with the program. These guest trays are killing me. haha. I will try to get back on soon.

Lo2us, are you attending the meetings? I haven't had a chance.

[Sugarbear 2]

by the way...Chellt...how did the surgery go? I believe your date was 8-27. Let us know how you are doing.

[newjulie 1]

Hello Ladies! don't ever hear from any "gents" on here!

Sorry to hear about some of the bad luck some of you are having. We've had a virus running thru our family, everyone has gotten it this past week but myself! I must be doing something right.

I have made a personal new goal of losing 20 lbs by Christmas. I've been staying in the box and have been exercising. I've gotten slack on the Water drinking, but I'm working on it. Going to try and make the Nashville meeting next Monday. The meetings always motivate me as I nearly always come away with a new revelation!

[tpagern 2]

hey everyone. I feel like I am back in the race again. I had another fill. Struggling with eating but doing okay. Lost 6 pounds. This is very very hard, but do able as they say. Never give up. I havent. I was eating way too many calories per day. I have to count them or I go over with the bad foods. Does anyone want to post what they are eating daily AND losing ? I would love it.

Thanks! Hang in there everyone !

[lo2us 1]

Hey,

I had my follow up MRI on Wednesday and it was the best possible news. It appears to just be a birth defect on my pituatary and nothing more. I have to do monitoring MRIs for 5 years and then I'm released.

Now I can get focused on my band. I have a fill schuedled for Monday though I'm not sure I need one. I see really tight all of a sudden. I think I will still go since I haven't been back since February and have been distracted with the brain tumor thing. TP I will try to remember to post with you, though I'm super busy...I'll do my best...

I've had one cup of hot tea today with 1tsp sugar. Will have 1 egg when/if my band permits for late breakfast!

[Sugarbear 2]

Hello everyone! Hope this finds everyone in the box! Glad things are better for you Lo2us. My mil has had a setback or two and I have been spending a lot of time with her. I hope we have her back on the road to recovery. Maybe I can get back into posting. I have an appointment the 19th. I think I'm a little tight, probably need a tiny unfill. Let us all get into a strong mind-set with the holidays approaching. BOX !!!!

[Sugarbear 2]

Thought I would get back on here and do a little posting...but...I see I was the last one to do any posting!! hmmmm. Com'on girls we need to keep our thread alive, especially for any new people that have questions. Had to get an unfill the other day. Hope this goes well.

[lo2us 1]

I had an unfill too back on October and another semi tongue lashing from Dr. H., but it didn't bother me this time. I've let me exercise fall by the way side since starting my National Certification and I just can't fit it in. I do plan on hitting the gym in March when I have to turn everythin in. Gus is getting a Wii from Santa and I think Santa's getting me a Wii fit program and the women's fit program, so hopefully I can get up at 4:30 and do that before school until I can get back in the gym. Though I have to admit I weight about 20lbs less then when I was going to the gym, but I don't feel as energetic.

I go back for a check up today since I was so tight last time. I want a teeny fill, but if I see Dr. K, she wammies me every time! Hopefully I won't have to go back for an unfill tomorrow.

[Sugarbear 2]

I had a 2 pound gain, but still got a teeny unfill. Hope yours goes well.Surely they can look back on your history and see more than a teeny one doesn't work on you. I go back in 4 weeks to check out if it worked or I need a hair more out. Still really tied up with taking care of my mil. I will try to get back on and post.

Hope all you newbies are doing well.

[Sugarbear 2]

Awwwww, are thread seems to be slipping. Guess I got lazy after 2 years. Keep posting we may have some newbies that need us. Take care. Anybody that wants to email instead go ahead.

[~amy~ 1]

Texarkana Bandster here! I'm 6 days post op - had the procedure done at Wadley - coulnd't have been happier with the service!! Much better than the Surgery Center. I've had 2 procedures done at the Surgery Center, and while the facility is newer, it treats you like cattle being herded in and out.

I had reservations about doing the procedure at Wadley because I'd never been there before, but my insurance would only pay them, so that's where I had to go. It was a wonderful experience start to finish - everyone was sooo nice, and even sent me a get well card afterwards.

PLUS - they give you a private little room with a bathroom connecting to the pre-op area. Your family members have a recliner, a tv, phone, and a private space to stay while you're in surgery. They called my hubs every 30 minutes to update him on my progress. Everyone calls you by your name - and will take time to TALK to you.

The Surgery Center was nothing like that. They stick your family members in a huge waitring room with everyone else - the doc comes out to let your fam know how the procedure went, and then in no time, they're shoving you out the door. (I had a tubal ligation there, and a foot surgery.) I can't remember one person's name, and I know they never took the time to remember mine.

Hope this helps! :biggrin:

[Sugarbear 2]

Hello Amy. Congratulations and welcome to bandland! I am nearly three years out from surgery and had a good experience at Wadley as well. I know you will do well on your band journey. Just follow the rules and the rest will take care of itself. Don't over-do while you are healing. You want the band and your port to seat in place. That is so much better in the long run. Fills are much easier when the port is where it is supposed to be and ect. Good luck on your journey and we will help anyway we can. my email is sharonhenley00@yahoo.com if you want to email.

[~amy~ 1]

Thank you so much!! I am a little OCD, so letting the housework go this long has just about killed me. I'm trying not to overdo it, because the last thing I want is another surgery! I'm 6 days post op, and other than feeling gassy, bloated, tired, and sore - I'm doing great (...except the hiccups are awful!!!) I appreciate you starting this thread and for keeping up with it for this long! It is surely to be helpful to me! :biggrin: I plan on going to the next support group meeting at Wadley to meet more Texarkana area bandsters! Prayers for health and success for all of us! :thumbup:

[A lot less 1]

Did everyone get the email from Drs. H and K.?

This is it. It is rather lengthy but informative.

People,

This is an urgent message about some unsettling news.

Last week Wadley Regional Medical Center in Texarkana was informed by Blue Cross Blue Shield that they were immediately losing their Bariatric Center of Distinction designation, effective Friday February 26. They sent us this notification by email on Friday Feb 12 at 3:12 PM, I'm sure so we would have little time to respond to it.

We have established and been designated a Blue Cross Blue Shield Bariatric Center of Distinction for several years and were stunned to hear this news.

What was their reason? They said they only mean to certify centers that provide gastric bypass in addition to Lap Bands. They said that it was a mistake to certify us in the first place, and somehow they "overlooked" the fact that we did not perform gastric bypass for all these years.

This is difficult to believe. When we applied for the the Center of Distinction we provided Blue Cross Blue Shield with all of our operative data which clearly shows that we perform Lap Bands only. This is a decision we have chosen voluntarily since the safety profile is so much higher with a Lap Band than with the gastric bypass which requires cutting and stapling the stomach and instestines. So they knew that up front. Additionally, every 3 months for the past few years, we have provided our data to Blue Cross Blue Shield, which clearly shows that we are not performing gastric bypass.

What this means is that those patients who have a policy with Blue Cross that requires a Center of Distinction, which for our patients includes Blue Cross Texas TRS (for teachers), Blue Cross Illinois, and Anthem Blue Cross, they will lose the ability to have Lap Band surgery in Texarkana and have care in Texarkana for bariatric related procedures as of next Friday if the situation holds.

The nearest Bariatric Centers for Distinction are in the Dallas area and Tyler area. There are none in the whole State of Arkansas and the closest in Louisiana is way down in southern Louisiana.

I personally spent 3 days trying to reach someone who would listen to me. I was out of town when the message first arrived a week ago Friday, and when I got back to the office on Tuesday I immediately took action. I first called the Blue Cross Texas rep in Dallas, Celeste Stewart, but she said she had no say in the matter and gave me contact info for a rep in Chicago with Blue Cross Blue Shield, named Wendy Marinkovich. Ms. Marinkovich said I would need to talk to the Executive Medical Director, Dr. Carol Flamm, but refused to give me her phone number or email! On Tuesday, Ms. Marinkovich took my number and said Dr. Flamm would call me back.

In the meantime someone not connected with Blue Cross gave me the number for Dr. Allan Chernov, the Medical Director for Texas. I called him and got his administrative assistant. They took down my name and number but I never heard from him.

Wednesday, Thursday, and Friday, I made many phone calls and sent emails trying to reach someone. I still couldn't even get the contact info for the Executive Medical Director in Chicago, Dr. Carole Flamm, because they refused to get me her contact info. Luckily, on Friday I was able to find her phone number and email on the Internet. After leaving her a voice mail, and sending more emails to Ms. Stewart, Ms. Marinokivch, and Dr. Flamm asking that they please call me, I finally heard from Carole Flamm, MD at about 5:30 PM Friday.

We had a lengthy conversation, but she essentially said there was nothing she would do, and the decision to remove our designation as a Center of Distinction would not be reversed.

My personal opinion is that this is all a matter of Blue Cross Blue Shield trying to make more money, and keep their policy holders from getting the medical benefits they are entitled to.

Here is a story I told Dr. Flamm which shows Blue Cross Blue Shield behavior of placing money over a patient's health:

Back in 2007, my surgical partner, Dr. Keilin and I attended a conference entitled "Building & Managing Bariatric Surgery Centers of Excellence." One of the speakers was Dr. Michael-Anne Browne, at the time the Regional Medical Director for

Network Medical Management for Blue Shield of California. On January 23, 2007, she spoke at the conference and she was asked about the difficulty in obtaining third party payor coverage for bariatric surgery. Her verbal response follows: "The problem with Bariatric Surgery is not that it doesn't work. We know it works. The problem is that it has expensive up-front costs. The average return on investment is 4 years. The average Blue Shield of California client switches providers in 2 to 3 years [to another third party payor.] Therefore for every patient we approve for bariatric surgery we create a better financial risk for our competitors."

The point of the Regional Medical Director for Network Medical Management for Blue Shield of California was clear. Blue Shield of California will deny access to bariatric surgery to our clients for financial reasons, despite being aware of scientific medical evidence

indicating that those patients' health will improve with access to those services.

For those of you with Anthem Blue Cross, you might have heard in the news how the White House, the Dept. of Health and Human Services, and the House of Representatives Committee of Energy and Commerce are all investigating how it is that Anthem Blue Cross in California can justify their proposed rate hikes of 39% for policyholders, when their parent company had$2.7 billion in revenue in the last quarter of 2009 alone.

For some background see:Anthem Blue Cross Internal Documents

Here in our office, we provide our employees with Texas Blue Cross Blue Shield insurance. Each year we have seen our premiums skyrocket, and an annual rise in 20% is not uncommon. Yet the pay from Blue Cross Blue Shield, to us doctors as health care providers, has stayed the same or dropped most years. For those of you that have been with us for a few years, look at your EOBs. You will see we are generally making less each year for the same office visit. Or if you just had a Lap Band compare it with an EOB from someone who had one from a few years ago. We are making less each year. So where is this money from extra-premiums going? Not to pay health care providers, but rather to the profits of the insurance industry that is supposed to be giving you the medical care you pay for.

Think about it. For those policy holders that are paying for a service, i.e. access to medically necessary procedures including weight-loss surgery when medically necessary, they are not being given access to those services. Sounds like thievery to me.

Who does this affect? Directly it affects those policy holders mentioned above. But in reality it affects all of us. Because pretty soon, all flavors of Blue Cross Blue Shield may require surgery performed at a Center of Distinction. Also, what is to stop any other insurance company from sending an email at a late afternoon on Friday to a doctor or facility saying they can no longer provide a service to a patient? It is Lap Bands now, but it might breast cancer surgery, elective C-sections, spinal injections for back pain, or anything else in the future.

We applaud consumer watch dog groups watching this issue: ConsumerWatchDog.org

We must make a forceful stand now, which is why I am sending you this extraordinary message.

The typical insurance rep probably rarely hears from a doctor or patient. Please take just a moment to leave a brief message or an email to the following people:

Celeste Stewart

Blue Cross Blue Shield of Texas Specialty Programs Manager

972-766-6829

celeste_stewart@bcbstx.com

Dr. Carole Flamm

Executive Medical Director Office of Clinical Affairs Blue Cross and Blue Shield Association

312-297-5905

Carole.FLAMM@bcbsa.com

Dr. Allan Chernov

Blue Cross Blue Shield of Texas Medical Director

allan.chernov@bcbstx.com

972-766-1149

Wendy Marinnkovich

Manager, Network Credentialing. BlueCross BlueShield Association

wendy.marinkovich@bcbsa.com

312-297-6357

Additionally, I have another option I recommend. My brother is currently serving on the staff for the House of Representatives Subcommittee on Commerce, Trade, and Consumer Protection. It is the full committee, chaired by Rep. Waxman that is holding hearings on Anthem Blue Cross of California's exorbitant proposed rate increases. My brother pointed to me that Rep. Ralph Hall serves on one the subcommittees of that office. He serves on the Subcommittee on Health. Rep. Hall is the representative for many of us here in East Texas. A map of the district he serves is shown on this website:

District 4 - Rep. Hall

Please contact Rep. Hall on this urgent issue as well. The number for his Washington D.C. office is 202-225-6673.

For those of you who think you have no dog in this fight, let me remind you that if abuses by insurance companies are left unchallenged they eventually will effect us all. Here in Texarkana many gynecologists no longer perform obstetrics and won't deliver babies because of insurance and malpractice issues. One of our neurosurgeons does not perform intracranial surgery anymore so if you have a head injury from an accident, or a ruptured intracranial aneurysm or similar brain injury on a day or night he is on call, you will quite possible die in the local ER while the Texarkana hospitals try to get you transported to another city to the care of an neurosurgeon. There are rumors of another prominent doctor in Texarkana that may drop Blue Cross altogether because of fights they are going through to get paid on surgical procedures they have performed over the past year.

If you do nothing now, you might find yourself in the Emergency Room in the future needing care for a heart attack, stroke, appendicitis, or a whole host of problems, with no one to care for you.

I urge you: contact the Blue Cross Blue Shield reps I have noted above. Contact Rep. Ralph Hall. Get the word out on Facebook, MySpace, Twitter, and any way you can.

I will not give up. I hope you don't as well.

Dr. Ron Hekier

2717 Summerhill Road

Texarkana, TX 75503

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