N E 1 been Banded at Mt. Carmel col, oh

[nurse niki 0]

Good luck today Special K!

Angie, a scrapbook vacation...how awesome would that be!!!

I got a copy of the letter my PCP wrote and sent to Charlene. It was great, but it didn't mention anything about the last 6 monthly weights. I know the insurance company is going to need to see that, so I emailed him back today...hopefully I can get that all sent to Charlene by Friday and we can apply for coverage the first of next week!!! I can't wait!!! I hope I can get all the ducks in a row so I can have the surgery as soon as we get back from Disney March 6th!!!

[Thinner me 1]

Niki~ looks like you and I are running neck and neck! I'll be praying for ya.

[nurse niki 0]

Hey I think that is great TM, someone to enjoy the ride with!!!

[Sunrise 0]

Lol///////////when And Where? I'm There!!!!

[debbiek1 0]

Everyone is staying on course and getting all their stuff done.

I wonder how Sue is doing. We havent heard much from her since her last denial.

When i was going thru the process, I never even consulted my PCP. It was all between me, dr chobans office and my insurance. I am lucky in that my insurance didnt require a 6 month diet and any diet history.

but i just told my PCP what i was doing and that was that.

She was okay with it, though. thank goodness because i would hate to change doctors.

[SpecialK 22]

Here it is coming up on the New Year already - 3 months since I started my lapband journey - and I'm still jumping through hoops. I thought I'd recap here for my own record as well as share with others who may be considering lap band surgery how long things do take even if you are working at it and staying on top of it. They don't make it easy to do.

1. 2007 Oct 3 - Attended the Mt. Carmel Bariatric Program Information session held at Mt. Carmel East Hospital on the first week of the month. See their website for info.
   
2. 2007 Oct 10 - Confirmed my insurance (Aetna PPO) does have bariatric surgery as an option they will cover if you meet the required conditions.
   
3. 2007 - Oct 22 Mailed the application packet I received on Oct 3 into Mt. Carmel and this is quite a bit of info to complete on health history so you can be considered as a candidate for their bariatric program.
   
4. 2007 Nov 10 - Received acceptance for Mt. Carmel Bariatric program from Mid Ohio Surgical Associates with all the info I need to gather and medical clearances I have to complete before it can be submitted to my insurance. Paid a $300 program administrative fee out of pocket - not covered by insurance.
   
5. 2007 Nov 15 - Dr. Cunningham at Mid Ohio sleep Medicine gives me clearance letter required for sleep apnea based on prior sleep study info. Don't have to repeat this to get clearance! No Cost $$ Yea!
   
6. 2007 Nov 28 - Dr. Chawla appointment to begin cardiology clearance - basic exam and EKG and fortunately he's on my In Network doctors list so all I have is a $25 co-pay out of pocket. Requires me to have a chemical stress test and echocardiogram before he can write cardiac clearance letter for lap band surgery.
   
7. 2007 Nov 29 - Dr. Brenner appointment to begin psychology clearance required. Basic 1st appointment but identifies that she cannot write clearance letter for surgery without a written 200 question psychological test given, graded or evaluated by her then her recomendatioons from that test shared with me. $20 co-pay only out of pocket.
   
8. 2007 Nov 30 - Dr. Phil Price - my Mid Ohio Surgical Assoc/Mt. Carmel bariatric surgeon - initial appointment to discuss weight loss surgery options - agrees to perform lap band surgery and write letter to insurance for approval as soon as I can complete the clearances I am required to do. $25 co-pay only out of pocket.
   
9. 2007 Dec 3 - Attend required minimum 1 Mt. Carmel Bariatric Support Program Monthly meeting at Mt. Carmel West. Free!
   
10. 2007 Dec 5 - Primary Care Physician (PCP) requires $50 out of pocket administrative fee to pull 5 years of medical records from a remote storage and copy it to provide a required history of 5 years of morbid obesity BMI info for Aetna insurance clearance.
    
11. 2007 Dec 14 - Chemical Stress Test done on my heart as one of two special tests for cardiology clearance.
    
12. 2007 Dec 19 - Echocardiogram test done on my heart as 2nd of special tests required for cardiology clearance. Now need to find out results of tests and see if Dr. Chawla will write clearance letter first week of January or what is next. $$ out of pocket for 2 tests unknown. Will be submitted to insurance and we'll see.
    
13. 2007 Dec 18 - Initial Mt. Carmel Bariatric Nutritionist appointment with Michelle Strakowski, RD for nutriotion counseling diet history, etc. $200 cost out of pocket. Will try to submit to insurance but don't know if nutrition counseling covered.
    
14. 2007 Dec 21 - Psychological test cancelled 2nd time because of insurance pre-cert delays. Will now have to try for January and likely pay for the psychological test out of pocket.
    
15. 2008 - Jan 11 - 2nd Nutritionist appointment - believe I have either 3 total or 6 total still not sure how many minimum! $100 out of pocket per appt. but will try to submit for insurance to see if they will cover any of it.
    
16. 2008 - Jan 16 - 2nd PCP doctor appointment to document weight loss efforts and document BMI. $20 co-pay only out of pocket.
    
17. 2008 - Jan 18 - Psychological test (200 question written test) - Likely to have to pay out of pocket on this. $$ unknown

• To Do: 2008 - Feb - 3rd Nutritionist appt
  
• To Do: 2008 - Feb - 3rd PCP appt
  
• Goal: 2008 - March 1 - Submit for Insurance approval!

18. 2008 - Jan 18th - Psychological clearance sent to Mid Ohio Surgical Associates surgeon's office. Dietician appt and PCP appointment documentation from January appointments sent also. They think they can submit for insurance approval NOW! so my new revised goal is

19. January 22nd - Submit for Aetna Insurance Approval

20. January 29th - Receive Approval (for my birthday gift!)

21. ??? Maybe February banding????

[Thinner me 1]

:biggrin2: Morning Girlies!!

DH and I are heading to the James to see the oncologist this afternoon. Ugh! I hate going there even though I know everythings gonna be fine. I am holding onto Isaiah 53:5.

Niki~ lets ride my friend!! :wink2:

Sunrise~ Wouldn't that be awesome!?! I would love a "crafters vacation" I'm taking some small cross stich projects to do on the way to Fl..... once again, not the best at it, but LOVE it :pray2:.

Debbie~ I'm missing Sue too. I hope she hasn't given up. I know I would have been heart broken if I had been turned down.... twice!

SpecialK, I am praying for ya! What a great B-day gift!!!

Everyone have a blessed day!

[suecasb 0]

Hi TM, I haven't given up yet. I found someone to help with an appeal and will be sending it in this week....and keeping my fingers crossed. I also have a letter from my PCP to include this time.

My prayers are with you and DH..hang in there.

[nurse niki 0]

Hey Girls...Maybe we can have a little scrapbooking retreat? We can get together somewhere and scrap together for a few hours. We can chat about the band and scrap at the same time! I would be willing to set up some tables in our basement (if you don't mind all the mess) and we can hide down there for an afternoon. Heck, we can even bring some munchies and drinks and have a little party?!?!?

Sue--I am soooo glad you are still fighting this! Hang in there girl, it will be worth it!

Special K--I am amazed at how organized you are...actually I am jealous! Looks like you, TM and I will be band buddies! Things will be looking up for us before summer!

Debbi--Did your insurance not need 6 months of weigh ins? That would have been nice. Actually this is my second 6 months...I started over with new insurance. I would have been banded by now if that were the case!

TM--Good luck today! I am thinking of you and your DH!

[SpecialK 22]

I had a form last year sometime to complete and send in and I was just saying to my Mom this past weekend that nothing ever came of that. Ha!

Got a big packet of Jury Duty summons stuff for serving from February 1-29th! Whoa! Not just 2 weeks of jury duty but a whole month of having to report every day (I'm assuming just Monday-Friday) but my boss is going to have heartburn when I deliver this news to him tomorrow. I think its the kind of thing where I can go in the morning and if they don't need me that day, they turn me lose. Fortunately I work downtown almost next door to the court I have to report to, so the parking and logistics aren't an issue for me.

I'll have to let you know how it goes. I'm not even sure what kind of cases are heard by juries on the US District Court level or who the judges are. Guess I'll find out soon.

:huh2:

[suecasb 0]

I faxed in all the paperwork for my appeal to BCBS tonight... everyone please keep your fingers crossed ...

[SpecialK 22]

I just laughed and laughed when this one was attached to an email from a friend because I've been to so many doctors and things lately where I've had to get undressed and its not my favorite thing at all. By the last one I did, it was like "so what, they have seen it all before me!"

Enjoy!

[ginnee25 0]

Scrapbooking: I have a great place to go to in Grove City OHIO for the day if you want me to plan that. If you want to do a weekend gathering... Get a few definate people to get in on it and I will hook us up with hotel rooms and a HUGE ROOM with our own tables. (I love planning stuff!!)

Insurance: I never spoke with, wrote to, or did anything with my insurance. Riverside did EVERYTHING!!!!! I cannot stress to you how well organized this program is. If you are not banded, you HAVE to look into Riverside Methodist Hospital. The surgeon is Doctor Myers. Ask for Yvonne, Annie, or Rosa. They are all sooooo GREAT

[Thinner me 1]

Good evening girlies!!!

We got wonderful news yesterday!!!! The oncologist said he wants us to see a surgeon and have an ultra sound done, just as a second opinion. If all turns out good there he said we will just do follow ups every 3 months for at least 3 years then every year after that and consider it cured. If anything is found during the ultra sound, then we will have to do surgery and then chemo and radiation (NOT GONNA HAPPEN!) So, all in all, great news. We left there thanking God!

Sue~I'm so glad to hear from you. I am praying with all my heart that you get good news this time. I just know they are gonna approve you this time.

I would love to do a scrapbooking get together. That sounds like so much fun! I really want to do the Columbus meeting, but we will be gone during that one. If it can be scheduled after I get back (Jan. 31-Feb12) I will do my best to be there. Or maybe do another one after that. I just started scrapbooking around Thanksgiving, but so love it. My sister is into it too (she is planning on being banded at OSU). Just let me know when and where.

SpecialK~ I love Maxine, she just says it like it is. Very funny.

ginnee~ I've heard Riverside is very good. My PCP has 2 pts that have had WLS there, and he just raves about them.

Ok, time to see whats on the tv.

Everyone have a blessed evening!

[debbiek1 0]

it is a good suggestion for those not banded to check out riverside.

mt carmel is not that well organized. i wish they were but...

unfortunately, some people may not have much of a choice. mt carmel was the preferred hospital with my insurance. i could have gone somewhere else but they would not have paid 90%.

that was the deciding factor for me.