Dr. Miles or Dr. Schmitt patients

[gone 4 ever 6]

Ok.. don't know how to explain this but curious if anyone else has been through this. It's happened to me about 4 times now. I get this INSTANT feeling of something tickling and dry in my throat that causes fierce coughing for at least 2 minutes. Painful, embarrasing, breathtaking, tears in the eyes, etc. When it's happening, I'm not eating or recently ate. The best way for me to explain it is that its dry and tickling. Today I actually got choked and threw up trying to get it to stop. Of course it was just liquids bc it was so early but gross! Natually, the rest of the day, I can't eat much if anything. It's like it irritates the band and it's hard to eat for a while afterwards. Anyone else been through this?? May not even be band related. /QUOTE]

Hello Wendy, This might not help you any. But I have had this happen before, but I am an ex smoker and get those tickles every once in a while. (I don't know if you ever smoked or not.) So dry and irritating, and it seems like nothing you do helps it.

Congratulations on the ultra sound and listening to the little one's heart beat! The time will seem to drag, then before you know it, you have a baby! Good luck with your pregnancy. Hopefully you don't have morning sickness.

[JASON R 0]

ok theres a pic of the shirts i had made. kaninag if you come saturday i will bring yours then.

and im also going to get some more made up soon. so if anyone wants one let me know. it depends on size and shipping on the price. im not looking to make money on this so my cost is your cost.

one of the new ones is going to say " scares of a new life" and have the scares where i had the surgery done.

well time for bed!

[kaninag 35]

ok theres a pic of the shirts i had made. kaninag if you come saturday i will bring yours then.

and im also going to get some more made up soon. so if anyone wants one let me know. it depends on size and shipping on the price. im not looking to make money on this so my cost is your cost.

one of the new ones is going to say " scares of a new life" and have the scares where i had the surgery done.

well time for bed!

Whats going on saturday? OH yeah the meeting..lol. j/k Dont know if I'll be there, got finals coming up but I'll let ya know. If you come sunday maybe you could bring it then :wub:

Edited April 15, 2009 by kaninag

[razberry*kisses 0]

Hey about to leave for work but I weighed this morning and I have met the 50 POUNDS LOST... woohoo, seems like I have been stuck for LONG time but anyway I hope the scales are moving down alot soon.

Stephanie :wub:

[Fordgal88 7]

Way to go Stephanie!! What a huge milestone!! That is awesome!!

Congrats on the baby Wendy!! I know you are sooo excited! My aunt (who is 3 years younger than me) is expecting a little girl in August. I just love little babies!

I will be at the meeting on Saturday! Are any of you planning on attending the fashion show next week?

=) Hope all is well with everyone! (=

[razberry*kisses 0]

When is the fashion show? Is it at the meeting?

[Fordgal88 7]

When is the fashion show? Is it at the meeting?

Its April 25 at St. Vincent's Birmingham - in the Bruno's Conference Center. I got the info in the mail last week. I think it is $5 a person. I believe they are calling it the Celebration of Life. If anyone would like to meet-up and go let me know. Or if anyone needs to know where to go let me know.

From the videos I have seen - it looks very inspirational.

=)

[venzwife 0]

Grr... I got a denial letter today in the mail from BCBS of AL, but it was under my primary contract, which doesn't cover WLS (has an exclusion in the policy). I have two insurances, but my secondary is the one that covers it, not my primary. Dr. Schmitt's office submitted it to the wrong contract. This is a big confusing mess, but my husband works for Blue Cross, and tried to explain it to me. For billing purposes, they have to submit to my primary, and after the charge is denied, then the secondary pays. But for pre-determination purposes, they have to submit it to the contract that is going to pay out.

Dr. Schmitt's office filed it last Friday, so I guess I lost a week. I'll have to get them to re-file tomorrow, I guess. How dissappointing!!

What's so wierd is the letter was worded in a way that sounded like I didn't meet medical criteria:

Dear Patient:

A predetermination of benefits for the patient's proposed treatment is complete. Based on the information provided, it has been determined that we are unable to provide benefits for the following services:

43770 Lap place gastr adj device

These services do not meet our medical criteria. If you feel we have reached this determination in error, please feel free to submit an additional request to Blue Cross and Blue Shield of Alabama explaining why this procedure should be considered further.

This courtesy copy is being provided as a requirement of the Department of Labor Regulations. This information has been requested from your provider. No action is required of you at this time.

We appreciate the opportunity to review your request and hope that this information is helpful.

Sincerely,

Customer Service

It was denied the same day as it was submitted, Friday. My hubby said all of BCBS was closed on friday (except Customer Service), so it must have been electronically submitted. If your contract doesn't have benefits, it automatically rejects it.

I hate insurance!!

**Frustrated**

[JASON R 0]

im sorry to see that venzwife. just try to get them to try your other contract. and i hope it happens for you.

[venzwife 0]

Hey, anybody have BCBS AL that might be willing to share their claims report with me? You can black out your personal information. My co-worker and I went to the seminar together & wants to get the lap band, but her insurance only pays 50% of the ALLOWED costs for the Surgeon and Anesthesia. She's contacted Schmitt & Miles office, but nobody has responded back to her or given her the amounts. She's trying to decide if she can afford it or not.

We would be very grateful!! And if you don't have a scanner, you can fax it (it comes to my email as a PDF) to 1-866-410-6532.

[kaninag 35]

it would really depend on what type of contract the insurance company has with that Hospital BC they would get billed at a discounted rate depending on their contract. like the hospital i went to billed my insurance 30000 for total costs but it was discounted due to the contract they have with empire blue at 11000 total. big difference huh.. I think my total costs for the anesthesiologist was about 400. Either way she can always set up payments thru the hospital and make whatever she can afford payment wise each month. Hope this helps.

[venzwife 0]

Yeah, I know each contract is different, and that is the problem she is running in to. She is not in a position to finance or make payments, and will need to pay the whole thing as a lump sum, but she can't get any idea of how much that might be. I just figured someone on here might have Blue Cross Blue Shield of Alabama and have a claim statement.

[kaninag 35]

Yeah, I know each contract is different, and that is the problem she is running in to. She is not in a position to finance or make payments, and will need to pay the whole thing as a lump sum, but she can't get any idea of how much that might be. I just figured someone on here might have Blue Cross Blue Shield of Alabama and have a claim statement.

My bad, I was able to pull mine up if you look on the form I attatched at the top youll see charge and then all the numbers below that...hopefully this will help!!

Dates Of Service.doc

[JASON R 0]

ok my insurance only said they would cover 50% of the surgery and io would have to pay the other part.

i ended up paying about 1060 to dr miles and about 400 to the anesthesiologist. it wasnt over 1500 togather i know that. i will try to fine my paper work some where.

like kaninag said when they bill it it was way higher then they told me it would be then i ended up not paying that much. when you go in to have the surgery you have to sign a fourm tyhat gives you the amount to pay if they dont. it was like 6k i believe.

ok heres what i paid dr.miles.

from start to now.

first visit was 156-- i believe.

300.00 for pre-op visit

and 575.00 -is what bcbs didnt pay

and some co-pays along the way but nothing over 30 bucks.

now i did pay st.vincent east 100 dollars when i did my pre-op visit for the in out patient co-pay

and i had to pay the anesthesiologist close to 400 bucks. and i believe that is it.

Edited April 18, 2009 by JASON R

[JASON R 0]

and by the im sorry but i want be at the meeting saturday. unless i get off work early. i got to be there at 7 so im hoping im done by 9. so i might be late our not there. sorry.