Lucky # Sevens- July 07 Bandsters

[IndioGirl55 32]

I'm in a bad mood today.

I got a bill in the mail for my contribution towards the sleep study I had done in February. I called the Center and told them that when they first contacted me to confirm my appointment, I asked them at that time how much it would cost me. They told me it would be covered 100% by insurance. Great, I thought. She said all I needed was a pre-notification number. So I called my insurance company and requested one. I remember being told at the time that the Center I was going to wasn't part of my insurance company's network. That was all I was told. Stupid of me not to ask her if that meant I would be required to pay anything. I called the Sleep Study Center back and gave them the number, then went for the study. I thought that was the end of it.

Today, more than 6 months later I received a bill for my portion totalling $734. I thought it must have been a mistake. Perhaps because I was denied at first for surgery, that any claim relating to the surgery was also denied at first. So I called my insurance company again and was told "You were informed when you called for your pre-notification number that the Center in question was not in the network." I told her I was aware of that, but I wasn't aware I would be responsible for 40% of the cost. It wasn't me who initiated the appointment, my surgeon's office arranged it. They told me it would be covered 100% as did the woman from the Center who confirmed my appointment.

I'm annoyed (to put it politely). We already saved for our portion of the surgery. To date we've had to pay $52 for pre-op tests done at the hospital, a "deposit" of $400 at the hospital where the surgery was performed. This MAY be returned if the insurance company covers all of the expenses. So now I'm worried that I'll be responsible for even more costs.

When I agreed to surgery, I agreed to an amount that was to cover surgery costs and all fills. I thought that was going to be it. I'm discovering now there are hidden costs involved that I wasn't made fully aware of. I'm MAD!!! :mad:

Ruby

I understand your frustration - but gotta ask and don't mean to be mean- you don't know that if you are out of network that you have the pay a bigger portion of the bill?? My Doctor's office made all my presugery appointment - and said that they would make them with Blue Cross Doctors - but as those doctors called I pulled out my book - to make sure they we in network doctors. My doctor has a large program fee and that's his way of making more $$$$ - imho all these people are into making $$$ and they don't care who pays - in fact they rather have you pay since they then get more $$$ as insurance doesn't pay squat... My sleep study was $2300 insurance paid $500 - I paid $60 and that was that... Any test that you have done or any doctors you go to You have to make sure that they are in your network - To date my out of pocket has been $1,700 and this doesn't include program fee - So if you have only had $452 prior to the sleep study I would be happy - I haven't even got a bill yet from the hospital so who knows how much i am going to owe them. All i can say is I am sorry for your sistuation but yougotta check your insurance book and make sure that eveyone you go to is in network or you are going to have to pay tons more

[forgve70x7 0]

I am in the fill waiting stage and I am GAINING weight. I am not eating all that much. I did start exercising seriously but not 3 pounds worth in 6 days!!! My fill is Wednesday. I need encouragement. Why oh why can't I lose weight without the band restriction? When am I going to learn to just eat less? Why do I even want to eat? Why can't I get my thinking changed? ...........I did well for 5 weeks and I am beating myself up for "failing" for a few days, because it is just like before the band, great for 3 weeks, impossible for 1 week. How do I get past this. Will my fill do it for me? CC

CC,

I'm just wondering if you're getting close to "Aunt Flo" visiting too, because that could be part of your weight gain. I put on 8 pounds last month, and really freaked out about it, but the nurse said we need to allow ourselves at least 10 pounds each month that we could potentially put on.

Another thing to remember (and this is from my Doc) is that even though we got that band, the pouch hasn't really been created yet and the initial restriction we all felt was from the swelling in our stomach's. My dr's don't even count the weight loss from the time of my pre-op until the first fill. They look at the pre-op weight, then the first fill weight. They even say that the liquid and post-op diets are ways to diet that anyone would lose weight on.

I hope that helps, but don't feel down on yourself. Things will get better, it just takes a lot of patience to get to that first fill. I just had mine on Friday and am loving it.

~Nichole

[cazulay 0]

Lynette- I am going for the full marathon, it will be in Austin, but if I can only do 1/2 I will be proud of myself neverthless. I am training with a group, which is very motivational. I would never get up at 5:30 am on a Saturday if I weren't accountable to somebody! They said we can expect to lose 20 lbs. on the process, so we will see.

[Frustrated 1]

IndioGirl: I know you're not being mean. I'm more angry at myself than anyone else because I dropped the ball on this one and it's got me freaking out that perhaps I've made more of the same mistakes. Yes, I know it was my responsibility to check and I should have. The surgery co-ordinator told me I didn't have to make any arrangements, that she would do it herself. She had my insurance details and I trusted she would have arranged for services covered by my company in particular. But I didn't check and that's my fault. I don't want others to go through the same experience and intend to speak with the surgery co-ordinator about it when I go in for my first fill on Friday.

There were a few things that haven't quite measured up to expectations, this sleep study being the straw that broke the camel's back I guess.

- This was the very first time I'd been contacted about owing money for this procedure and I had it done more than 6 months ago. The insurance company paid their share back in February. What took them so long to get around to notifying me?

- I willingly paid $4200 for my out-of-pocket expenses for the surgery assuming they would be my total out-of-pocket expenses as I'd been told. However when I went for my final pre-op appointment AFTER I'd been approved by my insurance company, when I got a detailed account of what that money covered, it also stated "Hospitals may require further payment that is out of our control" or something similar. This was never mentioned at any previous appointment or call.

- I paid extra for pre-op exams at the hospital. I'm assuming now it will be the same for the post-op exams I had the day after surgery. There better not be charges for fills and I know for sure they said the money I paid covered ALL fills. I'll make sure I ask when I get there.

- I was notified by the hospital where I was to have my surgery less than 48 hours prior to it that I was required to pay a deposit of $400 that may or may not be reimbursed by the insurance company. This was just in case I needed an extra procedure or medication. This message was left on my voicemail and despite 3 calls each following day and leaving my own messages, I was never contacted by anyone to discuss the matter. My appointment had been made 4 weeks prior and confirmed the same day I got this voicemail. Nobody told me of this extra cost either time.

- I have written documentation up the wazoo, and even have a detailed list of whom I've spoken with on the phone and when throughout this entire process. Unfortunately I didn't keep notes on what was mentioned in all of the calls, and there have been many, many of them to get to the point where I'm at now. So even though I can say who I called and when, I don't always know what specifics were discussed on those times. At times pre-notification was required, at other times they weren't. Little things like that I've not kept track of.

These are the hidden costs that I think are unfair. If they'd told me at the time I would possibly have to pay another $1,000 to cover these costs, I still would have opted for the surgery. What I don't like are these little surprises I wasn't expecting that dull the shine off what is meant to be a brand new start on life for me. :straight If I'd known about them I could have been more prepared. I thought everything would fall into place the day my insurance company accepted the claim. It seems I'm mistaken.

I'm trying to stay positive and not let is stress me out as I know what effect it can have on me. At the end of the day it was my responsibility and I should have taken more care.

[NewCC 0]

Cazulay: I love all the stories of how much the first helped! Just thinking of it helped me a little today.

Dini: I loved losing weight during the pre/post op periods, I guess I got spoiled! I liked your taxi story.

Phyl: We will be almost fill twins. I go on the 5th. I thought you already had a fill - if not, you had to wait awhile. I bet you are really feeling ready!!

Nichole: I wish Aunt Flo (I never knew this term until you guys) was on her way, but sadly it is just my eating habits. Slowly learning things like: don't buy MY favorite Snacks for the "boys" to eat, b/c I WILL eat them all!!

I watched a Tummy Tuck on tv. I hardly ever watch tv but all my guys we on a father/son hunting trip. It was completely gross but oh my, I already want one!! I have a small hope that I might get by, because I am tall and I put on the weight more recently, but if I need one - wow - they work!

Several of you mentioned a show you watched called something like Big Medicine. What is the name of the channel that is on. My husband gets pretty much all the channels, I looked all around this weekend and didn't see anything that sounded like it, but after watching the plastic surgerys, I got interested. I'll be back tomorrow! CC

[forgve70x7 0]

Nichole: I wish Aunt Flo (I never knew this term until you guys) was on her way, but sadly it is just my eating habits. Slowly learning things like: don't buy MY favorite Snacks for the "boys" to eat, b/c I WILL eat them all!!

Several of you mentioned a show you watched called something like Big Medicine. What is the name of the channel that is on. My husband gets pretty much all the channels, I looked all around this weekend and didn't see anything that sounded like it, but after watching the plastic surgerys, I got interested. I'll be back tomorrow! CC

You know, the hardest thing for me to get over is the mind game that I'm playing with myself. I still want to eat the amount I used to and it's a constant battle to not eat the amount I used to. With the fill, it's getting easier and easier, but I know it's going to take time for my mind and my eyes to get used to this. Having the fill is also great on the snacks because you can't eat as much. However, you just have to watch eating things like chips because those will go through the band quickly and not keep you full for long!!

Big Medicine is on TLC - normally on Monday nights. The season just ended, but I'm sure you can catch the re-runs until the show starts up again.

I hope you get better, and I know once you get your fill you'll start seeing results again so keep your head high!

[Frustrated 1]

Several of you mentioned a show you watched called something like Big Medicine. What is the name of the channel that is on.

It's on the Discovery Health Channel. There's a show on tonight at 9pm my time (Texas), not sure what timezone you're in.

[NewCC 0]

Ruby & forgve, thanks, I'm near you. I am going to try to figure out how to record it right now! CC

[chimboree26 24]

Hey all! Hope you're enjoying this 3 day weekend. I'm at work, unfortunately. I work on a military base in a 24/7 operation. Oh well.

Lainy, congrats on those 18 lbs!!!

Hey Lynette! You'll have to post a pic so we can see that new do! As for the Constipation, I had this a while back. I was S-U-P-E-R miserable. I, too, am very normal. I've just upped my Fiber intake. I eat Raisin Nut Bran in the morning. This has got me back on schedule. I want to get my fiber in naturally (w/o having to take a pill/drink a mix).

Linda, I'll be joining you in purging my closets. This should be fun! Getting rid of stuff that doesn't fit anymore b/c it's too big...and we won't be needing them ever again b/c we'll never see those sizes again! Woohoo!!!

Forgve, sounds like your fill appt went really well! I'm still holding on until my first fill. And congrats on the 30 lb loss! That is awesome!!!

ShannonRT, how did your first post-op dinner outing go?

Hi Ribearty!! Soooo good to hear from you again! How's ething going w/you?

Dini, your back!!!! We missed you!!! That was wonderful that you got a chance to pamper yourself and have some me-time. And you have a bit more me-time since your baby's w/your mom.

[chimboree26 24]

NewCC, here, Big Medicine comes on TLC - The Learning Channel.

[ShannonRT 1]

Hi all. My post-op outing went well I think. I ate 3 chicken wings for an appetizer. I ordered this Mexicali chicken thing with broccoli and cole slaw. The chicken had cheese, onions and peppers on it and it was pretty spicy, so I only ended up eating about 4 bites of that. And I ate about half of the broccoli and a few small bites of cole slaw. I don't really like cole slaw that much, but I wanted to stay away from the fries and potatoes!

I had a good time with my neighbors and enjoyed the ball game even though we lost.

I did pretty well not drinking with the meal, but the chicken was so spicy I did have a few sips of Water. Then after an hour I ordered some iced tea and accidently found myself drinking it through a straw. But it didn't give me any problems. I haven't had a fill yet. Does that have anything to do with it?

[ribearty 544]

I normally don't toot my own horn, but have to in this intsance. I finally hit onederland. I haven't been there for over six years. My goal was to be there by Labor Day and I made it. I have lost over 28 pounds Now only 64 pounds to goal.

[cazulay 0]

Ribearty- congratulations! Brag away, it's a big accomplishment! I can't wait to join you. Enjoy!!!

[lindaa 1]

:clap2: Hourrah for Ribearty :clap2:

We all hope to join you soon!

[Frustrated 1]

That's onderful news ribearty! Congrats. :bounce: