Just beginning the research

[margo281 0]

I am new to the forum and just began checking out the lapband procedure. My husband and I are both looking into the procedure and are currently looking into doctors in the Houston Texas area. We have BlueCross blue shield of Texas and according to their benefits book will cover lapband beginning in 2007. I am currently at 36 bmi (but weigh about 100 lbs more than ideal weight) and my hubby at 38 bmi. I have thyroid disease and he has many other health problems that make him an ideal candidate for the procedure including weight induced diabetes.

I need some help and direction about the procedure, good doctors in my area and life after the band.

Thanks for the info....

[beachgirl 2]

Let's see. Well I have BC/BS but they wanted me to jump through hoops so I didn't want to wait so I self paid and had mine done in Monterrey Mexico. The surgery itself is a very simple, noneventful, quick surgery. I tell everyone and it's the truth I had more trouble with my last root canal than with my surgery. It's a quick 45 min. surgery with about one hour in recovery. There's usually no need for catherdars or no drainage tubes or nothing. You usually go home that day or very soon after. The healing time was very quick for me. I flew to Houston 2 days later and then on to Nashville. Day 3 I was cleaning house, doing laundry, doing grocery shopping and day 7 was riding 4 wheelers all day long on trails. I have had 4 fills but the last one was too much so I had to have a slight unfill. I have the 9.75cm inamed lowprofile port which hold's 4 cc's of Fluid and I'm currently at 1.6 cc's and it seems to be perfect. Life after the band is great. I can still eat everything I use to eat just much less. I lost 50 pounds the first 4 months and things have just been great. I think you will be very very pleased with your decision.

Good luck and feel free to pm me if you have any questions.

[margo281 0]

Wow you sound adventurous! Weren't you afraid to have it done in Mexico?

Unfortunatley I can not pay out of pocket. BCBS is just now including the lapband in 2007 after a psychological exam. That is all they are requiring and a 10% copay on allowed amount, but no one seems to be able to tell me how much I can expect it to be.

Any help there?

[juliegeraci 7]

Hi Margo, I have no idea how much my doctor cost was. I want to say just under 10k but I could be wrong. The expensive part was my overnight stay in the hospital which my insurance paid for. Now he does them outpatient. Good luck with your lapband discovery. I am really happy that I am banded. It is so freeing to be able to lose weight. Good luck.

[beachgirl 2]

In the states Margo it's usually between 18000-28000. I had 3 estimates before going to Mexico. I found one that was 13800.00 but it had to be paid in cash. I would say you could roughly figure around 18000 especially since insurance charges more than cash paid. Good luck and keep me informed.

I was afraid but I was using Dr. Sanchez who had done more of these surgeries than anyone in the world. All the local doctors I contacted had done 125 surgeries at the most and I just wasn't comfortable being someone's guinea pig. The hospitals and my experience in Mexico was better than any surgery I've had in the states. Better care, better facilities and just more caring nurses. Good luck.

[flabuless 18]

Welcome to LBT margo281 I have a hypothyroid condition and I was accepted for lapband...Best thing I have ever done...dont regret it in the least...the surgery (although I was pretty nervous going in) was uneventful and I was up and walking within the first 24hrs...you are to be congratulated for wanting to turn yours and your husbands life around...Best wishes on your search for answers..

becky

[JOinMN 0]

What more does a Insurance CO need before the actually "HELP" you??? I just called Blue Cross of MN.. they have 5 requirements... ALL must be done before you can have this surgery! THIS is not going to be a slow ride for me! yes they will pa y but you must jump threw all the hoops first!:faint: I'm so dissapointed

[HeatherGurl 0]

Margo,

Sorry that I am just now seeing your post. I used Dr. Spivak in Houston, and his surgery is $15K if you are self pay.

I highly recommend him

www.bandmd.com

Let me know if you have any more questions.

[kwhenrykerr 0]

Jumping through the insurance hoops is not fun. A check list of what needs to be done would help. The doctors that I have spoken to do not help much. The insurance company does not help much. It seems like doing your own homework is the only way.

A form for insurance requirements might help. The insurance companys have so many different requirements with each contract that they write. this is not by chance. The insurance contracts will change to confuse the doctors and insured so that payments do not happen. Doctors write-off the loss and are required to rase rates, the insured gives up or dies. Reality, be self-pay or suffer.

[TexasBr@t 0]

Well i have BC/BS and they would not cover it, tryed for 2 years to get it done and everything i would get for them still wasn't enough info.. the doctor who did mine was Speigal and he is in houston Tx.. and i to was selfpaid. and it cost me $15000 so your lookin about $1,500 on up depending what they charge the insurance company for your copay..

[margo281 0]

Thanks for the info about BCBS. I called them to check on the costs of the procedure and they had not even gotten the rate sheet in for the new year. Fortunately I have the benefits book and they did FINALLY approve it for 2007, so I have it in writing.

[ReneBean 3]

Hi Margo

Just be sure to check with your company HR to make sure they have not put an exclusion on your policy. While BCBS cover's it - your company may not.

If you determine that there is no company exclusion, then start jumping hoops. Consider it exercise...

It took me 4 mos to get approved thru BCBS of California - and I had to appeal twice.

Hopefully, you won't have the same issues I had!

Hugs!

[TracyinKS 7]

I have BC/BS of SC, and I am expecting on the high side my cost to be around $3000. BUT I have an HRA plan (not an HMO or PPO) My plan is where I have a pool of money $1125 and if I use that I have a bridge (fancy word for deductible) of another $1125, then it goes to 80/20 plan.

SOOOOOOOO what I did was put money in a Flex Spending Account to make up for my bridge and the extra...... this way I will have it all paid for with pre-tax money and paid for in a year.......... and if for some reason this flops..... everyone is getting a giftbasket with OTC stuff for christmas next year! LOL

Please keep us posted on your progress........ it is how we learn

[nicknack34461 0]

I heard if you are self pay that the cost is tax deductable does anyone know if this is true or not it would be nice

[lisah25 3]

I heard if you are self pay that the cost is tax deductable does anyone know if this is true or not it would be nice

We deducted DH's in 2004, and are planning to deduct mine this year. For medical expenses to be deductable, they have to total a given percent of your income, that wasn't a problem for us. I can't remember what that percent is, it's on the forms.

I was able to deduct my contributions towards medical insurance, co-pays for all office visits, WLS or not, and prescriptions.