Dr. Miles or Dr. Schmitt patients

[venzwife 0]

Hi everyone. I thought I'd say hello. I have been reading this thread when I was researching the band and trying to decide which doctor to go with. I think have decided on Dr. Miles or Schmitt, and I am going to the seminar this Saturday.

Can anyone tell me what to expect AFTER the seminar? Do I need to call them and make an appointment with the doctor, or what? I am going to TRY to get approved through BCBS of AL, but insurance approval always makes me nervous. I'll self-pay if they deny it. I know I have to do the 6 month diet, and I really hope they approve me.

Right now my BMI is 42, so I am good there, but it wasn't quite that high the previous two years. I've Yo-yo'ed for the last decade (since high school). I had a BMI OVER 40 my senior year, and the lowest I've been able to get it was around 33 (which was in 2004 - lost weight for my wedding), but I krept back up there after that.

My plan is going to be to try and submit dated pictures for the previous two years requirements. I have PLENTY of those. Ick. Its funny how I would get excited to find pictures that made me look fat! It's usually the opposite.

Anyhoo...I thought I'd say hello and ask about the seminar.

Did ya'll do your 6 month diet through their office, or did you do it through somewhere like Weight Watchers, etc?

Edited September 17, 2008 by venzwife

[alabamagirl1975 2]

Hi and welcome!

I did my 6 month diet through my PCP (primary care physician). She was really pushing for me to have the Lap Band so she was great. I am going to the seminar this Saturday too ~ I am bringing my best friend~I'm like you though, I have always gone up and down my whole life and now I am to the point to where I can make a difference. If you follow BCBS rules, they will approve you. That is what Naomi is for. After the seminar, they will schedule appointments for Dr. Miles and Schmitt. My suggestion is go to the dr. appointment first that way Naomi can tell you what all you will have to do (sleep study, cardiology, EGD, etc) ~ you can do your other appointments while you are working on your 6 month diet program.

Good Luck and let us know if you need anything!

April

[Savedbygrace 11]

Hi everyone. I thought I'd say hello. I have been reading this thread when I was researching the band and trying to decide which doctor to go with. I think have decided on Dr. Miles or Schmitt, and I am going to the seminar this Saturday.

Can anyone tell me what to expect AFTER the seminar? Do I need to call them and make an appointment with the doctor, or what? I am going to TRY to get approved through BCBS of AL, but insurance approval always makes me nervous. I'll self-pay if they deny it. I know I have to do the 6 month diet, and I really hope they approve me.

Right now my BMI is 42, so I am good there, but it wasn't quite that high the previous two years. I've Yo-yo'ed for the last decade (since high school). I had a BMI OVER 40 my senior year, and the lowest I've been able to get it was around 33 (which was in 2004 - lost weight for my wedding), but I krept back up there after that.

My plan is going to be to try and submit dated pictures for the previous two years requirements. I have PLENTY of those. Ick. Its funny how I would get excited to find pictures that made me look fat! It's usually the opposite.

Anyhoo...I thought I'd say hello and ask about the seminar.

Did ya'll do your 6 month diet through their office, or did you do it through somewhere like Weight Watchers, etc?

Welcome to the board!

Just like the post above me says ---- yes I forgot who posted it haha--

I would schedule the consult with Dr. Miles asap and get started on the other requirements as you're doing the 6 months for BC. Heads up, the consult is not paid for by insurance so you do have to pay for that. They should go over that in the seminar though. I did my 6 months through my primary phyiscian and a local nutrionist. It can't be done by the surgeon - per BC's guidelines. They do have some set guidelines so it's best to go online and print them out so that you don't do 6 months of the wrong thing. If you need help finding them let me know.

Wishing you the best!

[venzwife 0]

Thanks! I'm looking forward to the seminar. I can't wait to get this process started!

I don't have a PCP that I can go through. I've only just gone to the gyno on a regular basis, and don't feel comfortable going through his office. What doctor do you go to? Are they local in Birmingham? I'd love to switch to a PCP that is pro-band.

I'd love to go to a doctor instead of WW so I don't have to pay so much to weigh in EVERY WEEK. Especially if I don't plan on losing a whole lot. I have 5-10 lbs I can play around with, but I don't want to run the risk of dropping below 40 BMI. Do you know if they will do it at their office, or does it have to be done by an outside doctor?

[Savedbygrace 11]

I am doing great!!! I went to the Dr. Yesterday and I have lost 21lbs. omg.... I was so happy. I am very hungry though. I live off of shaved ice... My hubby left today and Im kinda down in the dumps and my house is so lonely... I am going to start walking today but l only get in maybe 300 cal's a day. so I have none extra to spair... What do I need to do?

CONGRATULATIONS CG!! That is WONDERFUL!! Keep up the good work and do what they tell you to!

[venzwife 0]

Okay....I just read the post by savedbygrace that says they won't do it at their office. Does anyone have a doctor they can recommend to do the diet?

[Savedbygrace 11]

Thanks! I'm looking forward to the seminar. I can't wait to get this process started!

I don't have a PCP that I can go through. I've only just gone to the gyno on a regular basis, and don't feel comfortable going through his office. What doctor do you go to? Are they local in Birmingham? I'd love to switch to a PCP that is pro-band.

I'd love to go to a doctor instead of WW so I don't have to pay so much to weigh in EVERY WEEK. Especially if I don't plan on losing a whole lot. I have 5-10 lbs I can play around with, but I don't want to run the risk of dropping below 40 BMI. Do you know if they will do it at their office, or does it have to be done by an outside doctor?

I actually used my GYN which is more of a primary care doctor (for me) bc I too have a hard time finding a primary care doctor that I like. Still don't have one as a matter of fact. BCBS states you can't use the surgeon.. which makes sense bc OF COURSE a surgeon would say you need it. I live in Huntsville so I couldn't advise on a Bham pcp.

BCBS's policy is here.....

https://www.bcbsal.org/providers/policies/final/031.pdf

[alabamagirl1975 2]

Okay....I just read the post by savedbygrace that says they won't do it at their office. Does anyone have a doctor they can recommend to do the diet?

I don't know where you live, but I used Dr. Melanie Miller in Trussville. Her sister was banded in 2006 and according to Dr. Miller she has done great! I will tell you right now, if you loose any weight during the 6 months BCBS will not cover the surgery. I think they give you a little bit of lea way but not much.

[venzwife 0]

Thanks alabamagirl1975! I'll give her a call. Question...insurance doesn't cover the doctor's visits for a supervised weight loss program does it? How much did ya'll end up paying in doctor's fees for that?

[aprilapple 1]

Okay....I just read the post by savedbygrace that says they won't do it at their office. Does anyone have a doctor they can recommend to do the diet?

Hello and welcome to the forum! I have been reading your posts and decided to offer my two cents:

1. Immediately after the seminar you will be able to schedule your consultation.

2. The consultation is about $160-$177 I can't remember but you have to pay it at the consultation.

3. Go ahead and stay for the support group meeting. One attendance is required before the surgeon will operate on you.

4. I used Andy Maddux at Edwards Lake Medical Center (3 min from the hospital) He is definitely a friend to the process and works well with miles and schmitt office. He was actually referred to me by someone affiliated with the office.

5. Do not lose a pound on your six month diet, especially if you barely have the bmi. Mine was right at 40. I actually put on a couple of lbs during the 6 mos. But oh well. They'll be gone forever pretty soon.

6. I have BCBS AL PPO (PEEHIP) and I used Photos and I was APPROVED about 2 1/2 weeks after it was submitted. ( I didn't go to the dr. 2-3 years prior , shame on me)

Hope this helps!

Edited September 18, 2008 by Apple8<)

[alabamagirl1975 2]

Thanks alabamagirl1975! I'll give her a call. Question...insurance doesn't cover the doctor's visits for a supervised weight loss program does it? How much did ya'll end up paying in doctor's fees for that?

Dr. Miller coded the visits to where BCBS paid for them, I only had to pay the co-payment. I paid around $153.00 for the initial consultation and in about 3 weeks I received a check from BCBS reimbursing me for that visit! But to be honest, Aprilapple is correct. DON'T LOOSE A POUND! What you have to do is prove to BCBS that you need this surgery ~ and the more paper work you give them, the better. What got me approved so quickly is that I had over 10 years worth of Dr. documentation showing my weight fluctuations over the years and all of the medical issues I have gone through due to my weight. I was approved in about 2 weeks.

You let us know if you need anything ~ with all of us who have gone through the surgery and the approval process ~ you will have a WEALTH of information!! :crying:

[crazgirl2006 0]

Thanks you guys, you all have just been great! I guess I need to start keeping up with what I eat.. BROTH< BROTH<WATER and Water lol

[venzwife 0]

Alabamagirl1975, I didn't realize we had to have an EGD and Cardio test!? I guess that a Schmitt/Miles requirement and not BCBS. How much does that cost? I would love to get all of this stuff taken care of during the 6mos diet, but if I don't get approved through BCBS, I'd hate to have to pay for all of these tests out of pocket.

Thank you ALL for your help! Y'all are wonderful & have answered so many of my questions! I hope I'm not bugging you if I have more down the road.

Edited September 18, 2008 by venzwife
Forgot to add something.

[JASON R 0]

Alabamagirl1975, I didn't realize we had to have an EGD and Cardio test!? I guess that a Schmitt/Miles requirement and not BCBS. How much does that cost? I would love to get all of this stuff taken care of during the 6mos diet, but if I don't get approved through BCBS, I'd hate to have to pay for all of these tests out of pocket.

Thank you ALL for your help! Y'all are wonderful & have answered so many of my questions! I hope I'm not bugging you if I have more down the road.

hi venzwife, and welcome to are little group here. i will help in anyway i can. i used dr milesto do my band. i think i had to pay 156 our 159 for the first visit with him, but i didnt get it back from bc/bs. then i done my 7 month visit with my family doctor. which was under dr miles before he came to southside al. so he new the process well. he got me to say i had a cold our something like that for my visits with him. that way bc/bs paid for them. then i had to do a one on one with the nutrition with ashley. i had to do sleep study which you will have to do. i would say to do it first during the 7 months it takes to do the diet. i did pictures for the bc/bs to show proof of my weight for a long term. i gave them 10 years of them. one per year.

on the test you asked about you do them after you get approved and set a date for sugery. you get them done when you do your pre op visit. and dont sweat the small stuff its not hard to do.

it took me over a year to get things in order to have it done. but i stayed in there and now im banded. so dont let anyone our anything get you down. thats we are here, to talk to and get help. i will be at the support group meeting saturday if you would like to ask anything.

on a side not to everyone i got my letter from bc/bs from the surgery. its the hosptial part. it cost 28xxx and they took 75xx for it. thats with my 100 co-pay. i dont want to see the one from dr miles office.

[aprilapple 1]

Alabamagirl1975, I didn't realize we had to have an EGD and Cardio test!?

I didn't have to get an EGD or Cardio...