Dr. Miles or Dr. Schmitt patients

[Savedbygrace 11]

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!! :thumbup:

Hey AG! How did you get BCBS to reimburse you for the initial consult? I could sure use that money! Did you file it yourself? Any help would be greatly appreciated!

[Savedbygrace 11]

Hey Venzwife! Your questions are never a problem!! That's what we are here for. I was full of them before surgery too so ask away.

I only had to pay for my copays during the 6 months. I'm sure the doctor coded it as a follow up for other problems I was having at the time too. I lost like 10 pounds during my 6 months but my BMI STILL is not under 40 so I didn't have a problem getting approved even with the loss. I don't figure you'll have a problem with getting approved as long as you follow the guidelines.

[alabamagirl1975 2]

Hey AG! How did you get BCBS to reimburse you for the initial consult? I could sure use that money! Did you file it yourself? Any help would be greatly appreciated!

I honestly don't know. I think the dr's office filed it againist my insurance just to see if they would pay for some of it ~ it worked! I was shocked!

[Fordgal88 7]

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

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

I think those tests are dependant on your health situation. I only had to have the sleep study and bloodwork done by my pcp.

I had my seminar in August 2007, first appt with Dr. Miles on October 4, 2007 and had my surgery on May 6, 2008. So appr 9 months from start to finish.

=) Still hoping to be able to attend the meeting tomorrow. But I have sooo much to do for the wedding tomorrow afternoon, it is still iffy.

Hope everyone is doing well!

=)

Shawna

[Di4AU 1]

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.

Not everyone does, just depends on any health issues you might have or even age. I had to go the heart doctor (who I LOVED by the way) and I suspect because I had taken Redux years ago, which was taken off the market due to heart damage.

Some people have to have a phsych evalutation, as well. I did not, but I think it's because I was very thorough on the application regarding my attempts at weight loss over my whole life. I think they're looking for eating disorders or other food related problems.

You will have to have a sleep study. I did all this in the first month or two of the process. Just get it over with so you won't have to worry. Just see the doctor monthly (and don't skip a month, or you have to start over). The first visit with your PCP doesn't count in the six, so it's really 7 months.

BCBS will pay, as long as you follow their guidelines, which are easy. It's all the Miles/Schmitt requirements that will drive you nuts! Although, to be honest I know a lot more about my health than I did!

[alabamagirl1975 2]

Same here. I found out a great deal of issues I was having was related to my weight. I was diagnosed with MVP years ago, so that was why I had to have a cardio eval. - I also had to have the psych eval due to some meds i'm taking. Don't worry, I'm not violent or anything! Di is right, it just all depends on what your are experiencing or have in the past.

[venzwife 0]

Thanks y'all! What a wealth of information you all are. :-)

savedbygrace, I'm glad to know that you were able to lose a little bit in the 6 mos diet and still be approved. I was REALLY worried about that. I have about 9-10 lbs leeway to play with and still be above the 40 BMI. I am MISERABLE right now, and didn't know if I would be able to maintain exactly at that mark without either gaining (which I didn't want to do), or losing, which I was scared of doing. I'm going to try and maintain, but if I lose 5-ish, it's good to know I will still be okay.

Can you go and have a sleep study done BEFORE your meeting with Dr. Miles/Schmitt? Do you tell them you are trying to get a lap band, or do you need to be referred from anyone? I'd be happy to go ahead and get that out of the way, but I want to make sure I don't do it the wrong way & have to do it over again. My husband has sleep apnea, and I would like to go to his doctor.

Thanks!! :thumbup:

Edited September 19, 2008 by venzwife

[Savedbygrace 11]

Can you go and have a sleep study done BEFORE your meeting with Dr. Miles/Schmitt? Do you tell them you are trying to get a lap band, or do you need to be referred from anyone?

Thanks!! :thumbup:

I don't see any reason why that would be a problem. I didn't have a referral. I just called a local one and scheduled it. They had me fill out a long history form and I noted that I was needing it for surgery clearance. Upon filling out the forms, some of my honest answers were symptoms of sleep apenia so I did have to do the study. Insurance paid for it. I had to doctor note that he was fine with me having the surgery, got that note and faxed it in to Neoami. So ......... yes.. you can go ahead and get that part taken care of.

[Savedbygrace 11]

Roll call again.... who all is going to the meeting tomorrow?

[venzwife 0]

I'm going to the seminar, but not sure about the support meeting afterwards. I would love to stay, I'm going to be bringing my husband to the seminar, and I think he would be chewing through walls if he had to stay all the way through the support group meeting. How long do the support meeting typically last?

[Savedbygrace 11]

My husband went to the seminar with me and he ended up being intrested in it and said Dr. Miles had him about talked into getting it haha... We drive 2 hrs to get there so he didn't mind staying for the meeting.. plus you have to go to at least one before they will schedule the sugery.

[venzwife 0]

I'm hoping he will want to stay. I would love for him to get the band too, but he's not ready yet (I don't think), and I don't think BCBS will cover his. His BMI is has been in a 35-39 range for the past 3-5 years, and he has sleep apnea, but I don't think it is severe enough. (stop breathing 50+ times an hour is I think what you are supposed to have, and his isn't that bad)

Poor thing has hypothyroidism too, which is being treated with synthroid, but I still think it makes him lose slower than he should when he tries.

[aprilapple 1]

sorry guys I won't get to chat with you all or share war wounds :thumbup: tomorrow. Its my 4 yr old's first soccer game of the season. Report back and give me all of the details. Ttyl

[Di4AU 1]

I'm hoping he will want to stay. I would love for him to get the band too, but he's not ready yet (I don't think), and I don't think BCBS will cover his. His BMI is has been in a 35-39 range for the past 3-5 years, and he has sleep apnea, but I don't think it is severe enough. (stop breathing 50+ times an hour is I think what you are supposed to have, and his isn't that bad)

Poor thing has hypothyroidism too, which is being treated with synthroid, but I still think it makes him lose slower than he should when he tries.

I was so glad my husband went to the support group meeting. I had been through so much education on the process and it was great for him to learn so much about it as well. It really is so different from the seminar, you get to ask much more in depth questions, especially ask those who are already banded which is not only educational but inspirational.

[alabamagirl1975 2]

I will be there for the seminar and the support group meeting. Sorry I didn't respond yesterday ~ I had to catch up on homework! I am bringing my best friend to the seminar so she can get started. If you look for me - I will be wearing a gray Alabama T-shirt. Sorry Di...ROLL TIDE!!! :thumbup: