New 60+ Thread

[docsly 0]

Rosie, I ate less than 1200 calories for one week and less than 1000 the second. Lo-fat food is the best way to do it. Just eat healthy and no sugars or heavy fatty food.

[MaRosie 0]

Hi everyone and thanks for the info Docsly.......Today I got some bad news, medicare is requring that i go to classes for 6 months before they will ok the lapband......I don't know why or if this is the norm but i sure am sad, although if that is what I have to do then I will.....I am 67 and just feel like I am running out of time......has anyone else gone thru this? Boo Hoo, but I will hang in there. I got my dates starting Sept thru Jan and then I hope that will be it and I can be banded........Rosie

[phyllser 3]

Today I got some bad news, medicare is requiring that i go to classes for 6 months before they will ok the lapband......I don't know why or if this is the norm but i sure am sad, although if that is what I have to do then I will.....I am 67 and just feel like I am running out of time......has anyone else gone thru this? Boo Hoo, but I will hang in there. I got my dates starting Sept thru Jan and then I hope that will be it and I can be banded........Rosie

I sure understand your frustration, Rosie.. and Don & others!

And I sure feel BLESSED, because I had no such requirements or waiting period! I had my first appt with my surgeon in May of last year and had my surgery 7/20/07. They didn't even require a psych consult?! They used cardiology workup I'd had the previous August. Nutrition consult was about the extent of my required preliminaries! Go figure!! And this was a fairly large bariatric practice/clinic doing a LOT of bypass and LapBand surgeries. I didn't realize how quickly I was able to get through the process until I started reading all your posts! At the time, it seemed to me that I was waiting FOREVER!!

My heart goes out to all of you playing the waiting game!

  

[JoannMarie 0]

Rosie, I'm so sorry you have this wait. I'm a Medicare patient, too, and did not have to do this diet. However, I had a 7 month medically supervised diet with a medical center (liquid diet similar to Optifast) within the last 2 years. I had all the paperwork (dr. notes, lab results, nutrition education, etc.) from that program (I also gained the weight back!). I believe that was acceptable as a medically supervised diet so I didn't have to do it again. Phyl's cardiology report may have done it for her. Still, my seminar was in April and all my paperwork was in within a few days from the seminar. I had to have a sleep study (done on Aug 16th). My surgeon consultation is TOMORROW, and I should get a date set then. I've been told it should be late October or early November. That will be 6-7 months. I do know Medicare pays a fraction of what other insurances and self-pays pay, so my guess is that Medicare patients are placed in the mix of patients so the surgeon and hospital are making a steady stream of income to provide for their expenses and profits. That is just MY GUESS, but let's face it - they gotta make a profit or nobody gets it done... Some surgeons have opted out of Medicare and charge the full amount, even if they are affiliated with a Center of Excellence. I have run into that here in the KC area. Be very diligent and call often enough that they remember your name when you call. The old adage "the squeaky wheel gets the grease" is a good one to remember. That's what I have done, always pleasant and easy-going, but always around. Good luck to you - and don't give up. Hopefully, as soon as you finish this 6 month diet, you will get your date!

[SueFromMichigan 1]

I, too, feel bad for those of you who have such a long wait and all those requirements. I probably set a record for getting my band quickly. We didn't get home from Texas till April 4th. Thus I didn't make my first inquiry about lap band till mid April. I went thru Beliteweight, and got everything done in one month. My surgery was 5/16.

My Medicare insurance is through Humana Gold Choice. It was an option offered to us when we signed up for Medicare part D, but it's really a complete insurance plan (Advantage plan?). They just take our Medicare premiums, nothing additional, and the insurance is better than straight Medicare, especially for preventative care. I had been on Medifast at one time, but that was over 10 years ago. My primary doc wrote a nice letter about my need to lose weight and inability to do so. She also sent info about the stress echocardiogram I had about 9 months before. I had a psych consult locally and that was it. Humana has a special Bariatrics division, they approved the surgery in 2 days after they got the letters. I still had to go to a Center of Excellence and stay overnight, which they said was the Medicare requirement. I went to Detroit, about 200 miles away. This was arranged promptly by Beliteweight .

As for Medicare paying less, I'm not so sure that is true. Beliteweight offered the surgery for self-pay people in Detroit for $11,000, including accomodations one night before & one night after. My Humana Gold Choice Medicare paid the hospital over $23,500, plus the anesthesia and some lab and pathology I needed at 100%. I never received a separate bill or EOB from the physician - I think his fee was included. As the surgery was inpatient, my only expense has been $625. Needless to say, I am very satisfied with both the speed and cost.

I don't know if I'd have had the resolve to persevere if I had to wait so long. I admire all of you for doing so, but I wish things could be speeded up for you all, also.

[JoannMarie 0]

Sue, from what I have been told, Medicare pays the hospital the normal amounts they would pay for any hospital stay, surgical care, etc. However, where the surgeon is concerned, they only pay approx $900 - far from what any surgeon is charging for this surgery. Having supplemental insurance helps out some, but still is a very low payment. That's why some surgeons are opting out of Medicare. Now - to qualify - I heard this first from a surgeon's office, and one who does not contract with Medicare so he can charge his normal fee for the surgery. I would take it with a grain of salt, but I've also read this on other threads on this site. The surgeon I am planning to use does contract with Medicare (as does the hospital), but even that surgeon's coordinator tells me she is never sure what payment they will receive from Medicare and the supplemental. It is my understanding that if they contract with Medicare they are bound to accept the Medicare payment + supplemental and not charge the patient for any excess. ALL of this is "what I hear" - guess I will find out soon enough. Please understand, I am not dissing Medicare. Bless their hearts - they take care of a lot of people with all kinds of medical problems and they do the best they can.

You really got this done in a hurry! I thought about the group you went to, but was concerned about the distance from my home. I am glad you had such a good experience with them. I've heard similar from others who chose that group. I actually have found that the wait, while I was not happy about it at first, has not been a bad thing for me. It's given me a chance to read a lot and make sure I really want to do this.

[MaRosie 0]

:thumbup:thank everyone for the words of encouragement......it's a bit of a set back but not one that is going to keep me from being banded. I was told that medicare of Montana just started doing this, wouldn't you know. I don't have to be on a diet, I don't think just have to attend 6 classes, one a month for 6 months....My first one is Sept 12 so I will know more then.

I will stay close and keep up on your progresses, and know soon I will follow.

Have a good day

Rosie

Ps. I still have not figured out how to get my pic. on my post.

[phyllser 3]

:thumbup:thank everyone for the words of encouragement......it's a bit of a set back but not one that is going to keep me from being banded. I was told that medicare of Montana just started doing this, wouldn't you know. I don't have to be on a diet, I don't think just have to attend 6 classes, one a month for 6 months....My first one is Sept 12 so I will know more then.

I will stay close and keep up on your progresses, and know soon I will follow.

Have a good day.Rosie

Ps. I still have not figured out how to get my pic. on my post.

I don't know if you can bargain with Medicare or appeal, but I think I sure would try!

You have to go to the page where you edit your profile. It's complicated and I always get frustrated every time I want to change my picture. But just stick with it. I've found the easiest way is to first get an account with "Photobucket.com". Upload your photos there. You'll have to resize it down to avatar size... I think there's a pre-set size that says avatar. Once you've done that, some little boxes pop up with various "codes" in it for your photo. Copy the one that says "direct" something or other. THen go to your edit profile page and .... I think it says upload profile picture or something like that. When you click on that a box will pop up asking you for the "url" address of your photo and that's where you paste in the code. Then, find where it says "change avatar" and if it worked.... your little picture will be at the very end of all the other little cutsie avatars. Then you pick that and "save". If your experience is similar to mine, by the time it works you'll be spitting bullets! :biggrin::biggrin::cool2:

I know there's a tutorial with great instrusctions and photos for setting up your ticker, but none that i know of for the photo stuff. Hope it works for you!!

[MaRosie 0]

I don't know if you can bargain with Medicare or appeal, but I think I sure would try!

You have to go to the page where you edit your profile. It's complicated and I always get frustrated every time I want to change my picture. But just stick with it. I've found the easiest way is to first get an account with "Photobucket.com". Upload your photos there. You'll have to resize it down to avatar size... I think there's a pre-set size that says avatar. Once you've done that, some little boxes pop up with various "codes" in it for your photo. Copy the one that says "direct" something or other. THen go to your edit profile page and .... I think it says upload profile picture or something like that. When you click on that a box will pop up asking you for the "url" address of your photo and that's where you paste in the code. Then, find where it says "change avatar" and if it worked.... your little picture will be at the very end of all the other little cutsie avatars. Then you pick that and "save". If your experience is similar to mine, by the time it works you'll be spitting bullets!

:biggrin::biggrin::cool2:

I know there's a tutorial with great instrusctions and photos for setting up your ticker, but none that i know of for the photo stuff. Hope it works for you!!

Thanks Phyllser,

I will try that and if you see my pic you know that it worked.....I did call medicare but didn't get anywhere with them....

Rosie:confused:

[skinnydippn42 0]

Sorry to hear so many people are or were have trouble getting Banded.

CMMC has been approved by Medicare. I have my 1st. meeting on Monday (09-08-08). It is suppose to last about 3-4 hours. They were suppose to send me a letter to let me know, but have not recieved it yet. I found out from another hospital that this hospital was "OKed". That sure was a blessing because I still would not have heard about it. As soon as the OTHER hospital told me I called CMMC as soon as I hang up the phone. They said they had one opening left next monday. (Talk about the squeky wheel).

So there you have it, it's finaly my turn.

Thank you for the Happy Birthday's, This could not have been a better Birthday present.

Don

PS: I have Medicare as my primary Ins. and Federal BC/BS as my secondary Ins. I was told this would take care of 100% of the cost. Time well tell.

Edited September 5, 2008 by skinnydippn42

[JoannMarie 0]

Don, that is great news! I hope everything goes well for you next week. You are on your way!

[Justmeuknow 0]

Great News Don Gods Blessing on your journey. And Happy Belated Birthday.

Carol

[Doddie63 6]

Post as soon as you can how you are getting along. Good luck. Your journey has started

[phyllser 3]

CMMC has been approved by Medicare. I have my 1st. meeting on Monday (09-08-08). It is suppose to last about 3-4 hours. So there you have it, it's finaly my turn. :thumbup:

Don

PS: I have Medicare as my primary Ins. and Federal BC/BS as my secondary Ins. I was told this would take care of 100% of the cost. Time well tell.

CONGRATS, DON!!

You've been waiting a LONG time!

[margiemm2 0]

Hi Everyone,

I keep getting lost on this site - but I"m back - at least for tonight - maybe if I bookmark this specific page, I'll find my way back more easily. I tried the pic but couldn't get it on so I will wait and struggle more another day. Congrats to Don for tomorrow's appointment. I, too, have an appointment tomorrow - my last weigh-in at the clinic in preparation for surgery on the 16th. People keep asking me if I'm scared yet. Strangely, I am not. At least not yet. Resolute. Has anyone had lapband with Dr. Posner in Buffalo General?

margie