Yet ANOTHER Texan!

[PJ333 0]

I'm just north of Houston, in the Woodlands Area.

Although I previously posted here, I thought I'd kinda re-intro myself as it's been awhile since I did so.

I plan on being a more active member :smile:

I'm a 38 year old mother of a beautiful 8 month old baby girl.

Having battled this beast of a thing called "weight" since childhood,

the overwhelming desire to see my daughter grow up has truly renewed my spirit to draw on all resources to win!

My husband is VERY supportive and we know that this will be a drastic change - for both of us.

Now..

The GOOD news!

After a very big let-down...I just want to jump for joy!

Our new (as of Jan 08) insurance, BCBS-TX, Customer Service has assured me that Lap-Band is covered!

Our previous carrier, Cigna - excluded the surgery.

So it is with renewed hope that I'm going to my Dr. Thursday in hopes of getting the ball rolling.

Having previously talked with my Dr. about the surgery, she recommended Dr. Spiegel or Dr. Wilkenfeld for the procedure.

She also told me that Dr. Spiegel, although is great, (her mom used him) his office is rather like cattle through the shoot there (not very personal.)

I'm looking into Dr. Wilkenfeld as an option as she said he is more personable and available to his patients.

If anyone has had experience with Dr. Wilkenfeld, I would greatly appreciate hearing about it. PLEASE!

I've also seen Dr. Spivak mentioned many times in the forums. Opinions are welcome!

I also want to thank the creators, administrators, and members of this site for their hard work and member participation.

From my browsing and lurking the past few months, I've learned so much and feel quite a bit more informed about the realities and expectations of this surgery and it's resulting lifestyle changes.

[NoMoreYoYo 0]

Congratulations on getting new insurance that covers it !!! :cool:

I also have BC/BS PPO and I am just starting the process - have a seminar on Monday to get the ball rolling. I live in Friendswood, btw - other side of Houston from you.

There are several threads on the Doctors forum about Houston lapband doctors. I originally wanted Dr. Spivak but he is out of network with BC/BS. Your coverage may be different, but you need to check.

My seminar is with Dr. Garth Davis who DOES take BC/BS and is in-network for me. Dr. Marvin is also in-network and I have a seminar scheduled for Feb 12th with his office. I will cancel if I really like Dr. Davis or keep the appt if I have any doubts and want to talk to another surgeon.

Good luck!

[PJ333 0]

Great to hear from you!

I called BCBS again today to ask a few more direct questions to ease my comfort in believing that his will definitely be covered.

After being let down before I guess I'm having trouble in trusting that it's true!

I verified that CPT code 43770 - Laparoscopic placement of an adjustable gastric band (Lap-Band) is indeed covered.

I have history of a Dr. supervised weight loss plan within the past 24 months, however, from what I heard today from Dr. Wilkenfeld's office, it may not cut the mustard for BCBS. It did not involve a nutritionist nor a written food & exercise log. I was prescribed phentermine and glucophage and walked a mile 4x a week. (treadmill) *sigh* I did manage to lose 25 pounds! I dicontinued the diet plan when my husband and I decided to have a child. Needless to say that weightloss had been regained and then some since the pregnancy :cool:

Anyone else have a Dr. supervised plan that did not have nutristionist & logs - and get approved????

[texasbandster 0]

Hi, I was banded on 1/4/07 by Dr. Garth Davis. I was self pay and had my surgery at University General Hospital. I knew Dr. Davis was the right Dr. for me after attending his seminar this summer. He certainly was plus it's always a plus to have a cute doctor. Just because your insurance plan is accepted by the docter doesn't mean your plan will pay. I have SCBS and Atena, husbands and mine, and BOTH exclude weight loss surgery. Oh well, mine is paid for, the surgery is over and I am on my way. I am really so happy I had the surgery.

First fill is scheduled for Feb. 11.

[PJ333 0]

Grats on the surgery!

I've not gone to a seminar in TX yet, though I had previously attended one for The Cumberland Center for Obesity in Nashville (where we lived before.) As far as knowing if Dr. Wilkenfeld is a covered under my plan, I've only checked on the BCBS website and found that he is indeed a covered provider. I've not yet made a decision about a surgeon. Just looking at options.

The only thing that I've verified thus far is that the procedure is not excluded by our policy :cool: *yea!* That is alot further than I got with Cigna in 07!!!

[alegna242 1]

Hi I'm new here. I have been pretty actively investigating the lap band for about 6-8 months now. I have no insurance so I am pretty much positive I'm going to Mexico Im in the woodlands area as well (Hi PJ333). The main thing I have been looking for on here is the monthly payment amount for the self payers. If anyone can direct me that would be great. I am 25 and gained weight with my 1st and only pregnancy. that was almost 7 years ago and I'm stuck at about 215, I'm 5'3''. I want to make a change for the better of myself and my family. Thanks!

[PJ333 0]

When we had found out that our previous insurance was not going to cover the prodedure, we had resigned ourselves to the fact that if I was to get this done it would be self-pay.

I had never thought of going to Mexico. Logistically, with the baby..etc - it just wasn't going to be an option.

We looked into self-pay options. You'll find that many surgeons offer discounts to self-pay patients.

Maybe that would be an option if you want to stay local.

We only moved to Texas a few months ago... so I'm very much still learning the lay of the land here!

It's been a challenge as we don't know anyone here.

Our house in TN sold at Thanksgiving and we'll be looking to buy another house in March. (Woodlands/Augusta Pines/Tomball area)

I think 2008 will be another year of big changes... hopefully all for the better!!!!

[Julia F 0]

Hello, Fellow Texans!

I moved to San Antonio from Indiana 3 yrs ago with my husband, who works for the Air Force.

PJ333, We have federal BCBS and the lapband procedure was 90% covered. From the time I went to the seminar until I was banded was 2 months. The surgeon's office (and insurance) required the usual meetings with the nutritionist and psychologist. BCBS asked for the past 5 yrs of medical records--I was pregnant the last two years back to back (I have a 20 month old and 9 1/2 month old!) and they accepted my OB's records...They also accepted documentation that I had attempted weightwatchers online.

The insurance approval process was a waiting game, but once the surgeon's office received the approval I was scheduled within a week!

Stay strong and faithful and continue your journey--Jump through all of the hoops, it is worth it in the long run!

[NoMoreYoYo 0]

Hello, Fellow Texans!

I moved to San Antonio from Indiana 3 yrs ago with my husband, who works for the Air Force.

PJ333, We have federal BCBS and the lapband procedure was 90% covered. From the time I went to the seminar until I was banded was 2 months. The surgeon's office (and insurance) required the usual meetings with the nutritionist and psychologist. BCBS asked for the past 5 yrs of medical records--I was pregnant the last two years back to back (I have a 20 month old and 9 1/2 month old!) and they accepted my OB's records...They also accepted documentation that I had attempted weightwatchers online.

The insurance approval process was a waiting game, but once the surgeon's office received the approval I was scheduled within a week!

Stay strong and faithful and continue your journey--Jump through all of the hoops, it is worth it in the long run!

I know BC/BS can differ in how their policies are written for different companies, but it is encouraging to know they accepted your Weight Watchers instead of requiring a 6-month Dr. supervised diet. I have WW weigh-in records from 1999, 2000, 2002, 2004 and 2006. Our insurance covers WLS so it is just a matter of getting all the paperwork together so it can be reviewed and approved.

If they need medical records for the last 5 years then I will have to go to 3 doctors - my ob gyn, my shoulder surgeon and my sleep doctor (I use a CPAP machine). No biggie - it will be worth it if and when I get approved!

[PJ333 0]

I'm hoping that my dr records reflecting my med supervised attempts will pass - even though I did not do diet/excercise logs. I've also requested my OB records as well - All from Tennessee.

We lived in the New Orleans area (Slidell) from 2002-2005.

I've requested my GP & OB records records as well. I just hope they still exsist!

Our BCBS has a $300 ded and we pay 20% of the cost after that up to a $3000 out of pocket cap. So I figure that We'll be looking at $3300 plus whatever co-pays we have beforehand at $25 each. Beats the crap out of $15k.

I've bumped a thread about fills and the CPT code for that procedure.

Does anyone know if they've created a code for the fills yet?

I had read an older post from 2005 that stated they didn't have one yet.

I'd like to know the code so that I can call BCBS to see if my policy covers the fills as well.

Any info is much appreciated as always!

[PJ333 0]

I had my appt with my GP today. I took in all my paperwork that I had. They have yet to receive my records from my other Drs that were requested last week. I'm sure they are on their way though.

My GP told me everything looked like it was in order and to go ahead and get registered for a seminar with a surgeon. I scheduled for a seminar next week with Dr. Wilkenfeld in Conroe. I've learned that they are moving their offices to the Woodlands/St. Luke's location at I-45 and 242 which will be very convenient for fills down the road.

We'll see how the seminar goes.

My BMI is 45.3 so the co-morbidities aren't an issue with my insurance.

Just a side note:

Weird... The nurse measured my height... I've shunk.

I was 5'6" in high school (at least I thought I was!).. I'm down to 5'5" now... :huh2:

[PJ333 0]

JuliaF

I sure hope that my prev attempts will be accepted!

Thanks for the encouragement!

(My hubby is former Air Force and is from Indiana... just a weird coincidence!)

[NoMoreYoYo 0]

Just a side note:

Weird... The nurse measured my height... I've shunk.

I was 5'6" in high school (at least I thought I was!).. I'm down to 5'5" now...

Same thing happened to me a few weeks ago - I used to be 5'2" and I was measured at the ob-gyn office at 5' 1-1/2". a 1/2" may not sound like much, but it is when you are only 5'2" to start with! :huh2:

[jojo30family 0]

Great to hear from you!

I called BCBS again today to ask a few more direct questions to ease my comfort in believing that his will definitely be covered.

After being let down before I guess I'm having trouble in trusting that it's true!

I verified that CPT code 43770 - Laparoscopic placement of an adjustable gastric band (Lap-Band) is indeed covered.

I have history of a Dr. supervised weight loss plan within the past 24 months, however, from what I heard today from Dr. Wilkenfeld's office, it may not cut the mustard for BCBS. It did not involve a nutritionist nor a written food & exercise log. I was prescribed phentermine and glucophage and walked a mile 4x a week. (treadmill) *sigh* I did manage to lose 25 pounds! I dicontinued the diet plan when my husband and I decided to have a child. Needless to say that weightloss had been regained and then some since the pregnancy

Anyone else have a Dr. supervised plan that did not have nutristionist & logs - and get approved????

I have BCBS out of New Jersey, but my husband and I live about 45 miles east of Austin. My insurance approved me 100% for the surgery and I didn't have to keep nutrition logs. I can tell you that the requirements for authorization from BCBS are extensive. My doctor's office, Dr. Ganta, has a wonderful office manager that handled all the paper work beautifully. Good luck!

[PJ333 0]

This is all encouraging news!

I don't want to get my hopes up but man o man... it's tough!

It sounds like it's all a game of "hurry up and wait!"

Hey YoYo.. guess we're going to have to start wearing heels