Newbie to Mass site with some good advise to anyone thinking of surgery

Hi All, I never knew there was a site for Mass WLS. I had my surgery on 10-15-05 at Brigham and Womens and i'm down 83lbs in almost 4 months. I work as a medical biller/insurance specialist so I know alot of the in's and out's of what gets approved and what doesn't at least to some degree I do. Also, the Brigham and Women's and NEMC are 2 of the most popular of the hospitals to have the surgery done. They have the best facilities and have done the most surgeries. If you are going to do it in a local hospital check it out thoroughly and see how many surgeries that they have done, they may be good hospitals but they may not have the reputation for doing the surgeries. I'm not saying that they are not good, but I know that Boston hospitals have the best reputations for almost anything they do. Lastly, check with your insurance companies before deciding on surgery. I know for a fact that Harvard Pilgrim, Tufts and HMOB are the easiest insurances to get approvals. All they require is that you go to 1 pre-op meeting before making an appt with your surgeon. Other insurances can have you waiting for 6 months or longer. With commercial insurances and other HMO"S other than the one's I listed they have you doing alot of things before you can get approval. You have to do 6 consecutive months of a diet, if you do 5 months, then skip a month then diet again, that won't be acceptable to them, you'd have to start all over again. They also want you to go to 1 group meeting for 6 straight months as well. I had Harvard Pilgrim they were great, I saw the surgeon on 9-1-05, made my surgery appt for 10-15-05 and got approval on 9-2-05. They paid 100% of the surgery which cost $47,200.00 or $45,200.00. The only thing I had to pay was $250.00 for nutrition consults before and after surgery, support meetings, phone calls from nurses/nutritionists, etc.. Compared to what I would have had to pay if I didn't have insurance I find that a bargain. I decided in August, 2005 after finding Obesityhelp.com to have surgery, I found the site on 8-21-05, went to a pre-op that week or the next week and booked surgeon appt for 9-1-05. Good luck to all who are having surgery or thinking of having it done. I'm glad I did. Lisa

Welcome! Sounds like you are doing awesome!

Hi Lisa, I had my surgery at Brigham & Women's as well on 8/2/05. I had Anthem Blue Cross PPO (I live in NH). There is s written exclusion in the policy I received for WLS; however, I was approved on the day of my consult and paid absolutely nothing, not even for nutrition. I am also so glad I did this. So far, it has been so easy and, except for a hernia, I have had no problems. Good luck to you in your continued success! Carrie

You are so right about checking your insurance before starting this process. I did alot of research before even contacting my insurance company and then seeing the surgeon. I knew up front what was required by Cigna and also knew they'd deny me on the first try. So expecting it to be 6 plus months was not a problem. Right now I'm waiting for my appeal letter to come back from dictation (Dr. Randall dictated it 2 weeks ago) so that everything can be sent in for my appeal. I'm learning to be a patient person even though I don't want to be..... lol My point is that knowing what to expect BEFORE starting the process helps you avoid the disappointments, discouragements and annoyances that can happen. That way you don't lose sight of what this is all about. Making friends in here has been wonderful. I'll get the WLS but just not on my scheduled time that I thought it'd happen. So now I've learned to just enjoy everyone in here until my time comes and I get to wave from the other side. Lorraine

Hi Lisa, I am having the surgery done on May 17th at the Brigham, with Dr. Lautz. What did you think of him? How is the post op program? I have not heard anything about their program either good or bad. Have you been happy with them. I find Eileen a bit harried an short tempered. Thanks Amy