My experience with pre-lapband testing.

[CAROL99 0]

Hello,

I started my Quest for a lapband in July of 2007.

I weighed 300 pounds.

My GP set up an appointment for me to meet with our local hospital team.

When I arrived for the first meeting in mid September I was informed our local hospital dr. would ONLY DO GASTRIC BYPASS ROEX EN Y procedure. The reason why was: lapband does not do as good of a job. Too much is reliant on the patients will to not eat fattening foods.....a RNY is more reliable because if the patient ate sweets the body would not tolerate it.

This was a VERY annoying end to what I thought would be a new beginning in my life.

I had to research my state to find a hospital that did do lapband.

A hospital in midwest WI was an hour from my home and they did do the lapband.

I made the appointment, which was again a delay. The first meeting would not be until early November!

I, and my friends, went to the 3 hour orientation and we all agreed the lapband would be the way to go. I was very excited and motivated to get on with my life.

I set up the required appointments with the psychologist and dietician.

Although Medicare does NOT require either of these BUT this hospital DID.

Again, I had to wait for these appointment until mid DECEMBER!!!!

While I waited I decided to start the pre-lapband diet. Basically, Protein and vegetables....no potato, flour, rice, etc....basically Atkins Diet! By the time I went to the two appt. I had lost about 20 pounds.

The dietician and I talked for 20 minutes. I showed her the diet I was on in journal form. Each and every day I had recorded what I ate.

She praised me for the good job and suggested I could come back to her on a monthly basis to 'touch base' until the lapband procedure.

I said I really didn't see the need.

I met with the phd. in the late afternoon of the same day....

After waiting for an hour in his waiting room....we talked for 15 minutes.

Then he had me take a written test of about 250 questions. He said I would then have to come back in to see him for the results.!!

I was not told this by the hospital...they said they only require ONE meeting with the dietician and ONE with the PHD.

I was baffled as to why these people were insisting on additional appointment...?

I waited two plus weeks to hear from the hospital as to the next step. The coordinator called me and said the dietician was happy with my motivation and weight loss.....but perhaps I would like to continue to see her until the surgery...

I said Medicare did not require it and I was lossing weight so I saw no reason to travel to any more appointments.

A week later this coordinator called and told me the results from the PHD. (psych) was in and after a few minutes of chit chat she said the results were, I was 'moderately depressed' and should mention it to my GP the next time I went to her!!!

I was also encouraged to see this fellow again for the written results.

I said I was stunned! I had no idea I was depressed!!

The coordinator said I shouldn't get too upset, everyone on the lapband road turned out somewhat depressed so it didn't mean too much.

I was so shaken by this diagnosis that I questioned my friends in the medical field. I asked two retired RNs and they said 'who wouldn't be depressed in my situation'....

I then wrote to a person I met on this site, who just happens to be in the medical field. They too re-emphisized that anyone in the lapband program would be depressed. This made me feel much better! How logical.

I called the coodinator of the hospital and asked what the next step was.

She said we had to wait until the PHD sent the 'written' report to her, Then we could request pre-authorization from Medicare for the Lapband.

So I waited.

Two weeks later, a nurse practitioner called. She said she was just looking over my chart.

She felt that I should have the Roex en Y procedure NOT the Lapband for these reasons:

They DO NOT do Lapband on ANYONE above the 40BMI range. I was at 49BMI at my initial weigh-in the night of orientation back in Nov.'07.

Also, the Lapband wouldn't prevent me from eating food that was rich in calories...the RnY would, therefore the RnY would be the route to go.

I told her I had been following their pre-op. diet and was now 24 pounds lighter.

I said I had never read that a lapband was not available to people my size.

I weighed 273 now.

She again said she felt the RnY would be the best route and that she would set up an appointment with one of the surgeons 'if I wanted' and they could go into more detail as to why the RnY was the route to go!!!

After more chit chat I asked what size lapband they usually use on patients. She replied, '4cc on most but 'my size' could be 10cc'!!!

Hmmm, didn't she just tell me 'they do not do lapbands on patients over 40BMI'?!:redface:

I said the ONLY procedure I was interested in was the Lapband.

If they could not do it then my journey with there hospital was done.

To which she now said, 'Oh well, ok, I will type up the pre-authorization request to Medicare for the Lapband.' 'Perhaps, you would like to see our dietician while we wait for the authorization.'

'NO, I said, the dietician said I was doing very well journaling my daily food and with my weight loss.' 'I see no reason why I should drive down and chit chat with her.'

Two weeks later, I recieved a copy of the pre-authorization request that they mailed to my Medicare provider...this was dated JAN. 18, 2008.

It is now April 9, I have not heard a word from this hospital!!!

I now weight 259.

I don't know what to think of this whole lapband experience.

I have lost total confidence in this hospital.

I feel they were trying to get as much money out of me as they could.

They baltently lied to me about not doing lapbands on people over 40BMI.

This morning a representative from this Lapband site emailed me and asked if I would come back to this site....I haven't been here in several months.

I am totally turned off of getting a Lapband now.

What do you think of my experience?

Is this normal procedure by hospitals in the bariatric field?

I'm confused and disappointed.

Carol

[faithmd 14]

Sadly your experience is not completely unusual. There are quite a few practices that have outdated beliefs that LapBand is not a good choice for someone with an over 40 BMI. Which to me is funny because almos all insurances REQUIRE a BMI of 40 to approve bariatric surgery (35 with two co-morbidities). I think there are very few people out there with an exactly 40 BMI who are at that office asking for LapBand.

I know it has been a very frustrating road for you already. I too had a long journey to banding and I know it really does make you want to give up and toss up your hands at the whole thing, but I implore you that if you felt banding was right for you, to please try again.

I agree that I do not think I'd want to go back to this hospital again. If you go to www . lapband . com (here's a link, it says "Home" in the text) Home they do have a searchable database where you can find the closest provider to you that does banding. Unfortunately that does not guarantee they accept Medicare, but at least you'd have a starting point.

I understand that traveling long distances for banding and all the appointments is a pain, but I have to tell you, if I had to travel six hours to get to see a surgeon I was comfortable with and who I trusted, I'd do it in a minute. Fortunately I only have to travel about 75 minutes on a good traffic day, but many of us here travel hours and hours, some actually have to fly to see their surgeon, but do it because that's what works for them.

I do encourgae you to try again, with a different surgeon. You should not have to start all over. You have logged your food, you should have medical records from your visits already and you have already had a psych eval with an MMPI-2 (the long test you took). Once you choose a surgeon you should be able to ask for a transfer of your records to the new surgeon (it might cost you a few dollars-many doctors charge some copying fees). You have already been pre-auth'd by Medicare so they know you've completed their requirements. And now you know of some of the stumbling blocks to look out for (like asking any new surgeon what their banding BMI is and if you know you want LapBand will they fight you for RNY)? You have done well with your weightloss and that shows you have the ability to stick to a plan and would very likely do well with a band.

I do wish you luck and I hope you are able to find someone you are comfortable with.

[Shamrockgirl60 1]

Wow what a horrible story. I just had my all day session with the shrink, dietitian and nurse practitioner at Lahey Clinic in Burlington, MA. I could not have gone any better. I weight 225 with BMI of 38.5 but have 2 co morbidities. Type II diabetes and just diagnosed with sleep Apnea. I spent about 45 minutes with each person. I did not have any 250 question test from the shrink. We just chatted and he asked me a reasonable series of questions. Same with the other two.

I left with instructions to lose 12-15 lbs. And call for appointment with the surgeon after I lose about 6 lbs. I have 4 meetings to go too and one more meeting with the dietitian. I called today to confirm that I am accepted and they said yes and congratulations. I feel for you problems that was awful. I would be depressed and discouraged also. Is there any other hospital around there that does this. I guess I am luck to live in the metropolitan Boston area with tons of great hospitals and clinics. A wide choice for me.

Take care and I hope you find another hospital to go to.

God Bless

[CAROL99 0]

Faith and Shamrock Girl thank you for your messages.

I have looked all over the state and the only recourse is to travel 4 hours to the next Bariatric Clinic.

This too is a CENTER FOR EXCELLENCE hospital just as the other one was.

I am too discouraged with 'the system' to persue another hospital.

I have invested over $200 in travel, appt. and time....for no good result.

I just do not have unlimited means to travel further and start this process again.

[flishi 0]

Hangin there. Everything happens for a reason. I'm still waiting for Dr. to request approval to insurance company. It's been 3weeks. And I'm suposto be "all Set" for a date. Keep your spirts up. Good luck!

[jena 0]

Can you appeal?

Don't lose faith in the lap-band. Keep after it!

I'm guessing because you are on Medicaid you have a much harder time than private pay or privately insured. Keep after it, though. States are beginning to look what Medicaid covers and they are removing bariatric surgery from their covered procedures. At least that's what I've heard from one of the seminars I attended.

Insurance companies are doing the same thing. I've got BCBS of GA and when I told my surgeons office who I was covered by she said "Oh, BCBSGA won't cover any bariatric surgery." So I'm self pay and going to a great place in Mexico.

You are doing everything right. You have completed your pre-op items. You've even lost almost 50 pounds and you have it documented.

Keep on pushing! I suspect when you do find a doctor, you will be able to get in right away!

This may seem like an obvious question, but have you talked to anyone at Medicaid?

Hugs and don't give up!

Jena

[CAROL99 0]

Thanks for responding,

I too believe everything happens for a reason.

Perhaps I am just not meant to have the surgery

I was SO positive lapband was the way to go....I guess there is a higher power that has other ideas.

I did learn that I had no concept in portion size.

I am losing weight on my own, which I truly did not believe I could, so that at least is a positive.

c.

[CAROL99 0]

Can you appeal?

Don't lose faith in the lap-band. Keep after it!

I'm guessing because you are on Medicaid you have a much harder time than private pay or privately insured. Keep after it, though. States are beginning to look what Medicaid covers and they are removing bariatric surgery from their covered procedures. At least that's what I've heard from one of the seminars I attended.

Insurance companies are doing the same thing. I've got BCBS of GA and when I told my surgeons office who I was covered by she said "Oh, BCBSGA won't cover any bariatric surgery." So I'm self pay and going to a great place in Mexico.

You are doing everything right. You have completed your pre-op items. You've even lost almost 50 pounds and you have it documented.

Keep on pushing! I suspect when you do find a doctor, you will be able to get in right away!

This may seem like an obvious question, but have you talked to anyone at Medicaid?

Hugs and don't give up!

Jena

Hi Jena,

It's not a problem of insurance.

I have Medicare not Medicaid.

Medicare DOES cover the lapband procedure.

I have not heard from this bariatric hospital since they sent me a copy of there request for pre-authorization from my Medicare provider.

The key words here are 'have not heard from bariatric hospital'.

There lack of follow through communication is appaulling!

There insistance of trying to get me to opt for the RNY (which is three times more expensive than Lapband) and....there insistance that I should go in for unecessary dietician and psych visits is disturbing....money money money.

I just feel if getting the lapband is all about money and not about health....I will do without!

C.

[Jess1982c 0]

Can you appeal?

Don't lose faith in the lap-band. Keep after it!

I'm guessing because you are on Medicaid you have a much harder time than private pay or privately insured. Keep after it, though. States are beginning to look what Medicaid covers and they are removing bariatric surgery from their covered procedures. At least that's what I've heard from one of the seminars I attended.

Insurance companies are doing the same thing. I've got BCBS of GA and when I told my surgeons office who I was covered by she said "Oh, BCBSGA won't cover any bariatric surgery." So I'm self pay and going to a great place in Mexico.

You are doing everything right. You have completed your pre-op items. You've even lost almost 50 pounds and you have it documented.

Keep on pushing! I suspect when you do find a doctor, you will be able to get in right away!

This may seem like an obvious question, but have you talked to anyone at Medicaid?

Hugs and don't give up!

Jena

Before you go to Mexico, I wanted to give you a heads up that I have BCBSGA and under my plan I am covered. It might be your plan that doesn't cover it, which means your employer did not want to include it in their offered plans, but I would definately double check. Because I have spoken to several different people at the insurance company and they all have agreed that I am covered (as long as I fit into the requirements).

[jena 0]

Before you go to Mexico, I wanted to give you a heads up that I have BCBSGA and under my plan I am covered. It might be your plan that doesn't cover it, which means your employer did not want to include it in their offered plans, but I would definately double check. Because I have spoken to several different people at the insurance company and they all have agreed that I am covered (as long as I fit into the requirements).

It is my plan that won't cover it. We are a small company of around 50 people and even if I asked that it be covered next year, I don't want to wait that long. Once I've made up my mind, I've made up my mind!

Like you said, most people don't realize it's not the insurance company that determines if you are covered, it's your companies coverage that determines it.

thanks for the suggestion!

Jena

[Bandme08 0]

Carol- congrats on your wt loss! Are you still considering the Band? I have tried, and succeeded in many wtw loss attempts on my own, just to gain it back- more power to you for your efforts and stamina to go it alone, if you arent' getting banded- Good luck!

[CAROL99 0]

Hi Bandme,

I think about... should I or shouldn't I get banded EVERYDAY.

There are so many pro's and con's.

My weight problem is... I have a very hard time with portion control...

I learned this through the way I am eating now.

I had to measure my food in order to get the correct amount....I had been helping myself to servings two + larger than normal and thinking it was the right size portion!!!

After months of measuring I do restrict myself to smaller portions but still have a tendency to feel I should 'eat the food before it expires'....this of course makes no sense....if it expires before I eat it, it would be thrown away...if I overeat just to use it before it expires it isn't doing me any good to add more calories and weight.....I now let it go to waste and throw it out if I don't have time to eat it.

It probably has something to do with my childhood and 'starving children in asia'.....that makes no sense either but that was a popular ploy to get kids to eat their food.

So back to the question....will I get banded?

NO, I DON'T THINK SO.

Not enough caring in the medical field....it's all about money.

[Pinkiegirl 0]

The pre lap land is the worst part. All the freaking testing and paperwork looping..

Surgery was easy compared to that.

[jamel8232 0]

I think you are doing great on your own with your weight loss. Everyone has a problem with "portion" size. Since you have "mentally" figured that one out, you are one step ahead of the game. And remember, the more weight that comes off, the better you feel and the more you do.

As for the hospital, that is not professional at all...but in their defense, hospitals see thousands of patients, have YOU contacted the hospital to find out what was taking so long. I hate to admit it, but sometimes you just fall through the cracks.

I wish you all the best luck in the world about what you ultimately decide. Weight gain/loss is a very hard road for everyone.

[bbala 0]

I feel your pain. Today I wrote down all of the appointments I have been to in preparation for surgery:

Seminar

Initial appointment with Dr. at surgery center

3 appointments with Dr. at surgery center for supervised diet

1 appointment with dietician

1 appointment for EKG/labs

1 appointment with psych

1 appointment with primary care physician

1 appointment with surgeon once supervised diet was finished

to go:

1 appointment for EGD

1 day of testing/dietician

1 final appointment with surgeon

my insurance was approved weeks ago and they won't schedule these final appointments until after insurance is approved, and first appointments are weeks away. I feel frustrated, because i'm finally approved and want to get on with it, and feel like i'm lost in hospital bureaucracy. I'm motivated to get the surgery, but COME ON, 13 appointments scheduled at the hospital's convenience ("we only do that test on mondays, and the first monday available is a month from now."). Arrrrrrrrrrrrrgh!