Should I seek another surgeon or what???

I was denied for Lap Band surgery in December. My surgeon and FED BCBS did not click very well so I am now looking for a new surgeon.  Dr. Harris requires his patients to stay overnight for Lap Band, but BCBS says it is not required and will not approve it with an overnight stay.  Back in December he had perform NO Lap band procedures, which may be why he wanted me to stay.  He has only done a few now since then.  Dr. Harris was not willing to change or fight the issue, so of course they denied it!  The nurse (Sara) called me and said "I can come pick up my records and do a patient appeal" Basically, they kicked me to the curb.   I was totally shocked because I thought Dr. Harris and his staff were better than that.   They sent my paperwork in wrong which was also part of the reason I got denied.  The letter from BCBS clearly states that they never received an Nut consult. Which I paid for an attended with Allison.  I was disappointed, but everything happens for a reason.  My girlfriend went through the surgery with him (Lap Band), but now she has a $30K bill, even though she had an approval letter.  She also has BCBS and she did stayed the night in the hospital.   The nurse told me "I could do it, but I may have a bill in the end".  I told her "NO"..because I cannot and will not pay you.  So that's when she said I can pick up my records and do a patient appeal.  I am going to take my insurance where the Dr. is able to meet there requirements and my needs.  I don't feel like he nor his staff were really concerned.  But more about getting as many people as they can and through surgery.     Dr. Harris is no longer on BCBS Bariatric Centers of Excellence.  I can either submit for RNY, with him or start the process again with someone else for Lap or RNY.  I have not heard anything from his office since December and really cannot believe how they handled the situation and by not sending in all the required paperwork.  I know some on the board have had him as surgeon and perhaps had better experiences.  But for me it was something different. 

What or who do you suggest??? 

Sorry to hear about all of your troubles. I am having the Lap Band next week and will be staying overnight, my Dr. requires it because I have sleep apnea. Do you know if he wanted for you to stay overnight for closer medical monitoring? If so, then insurance should approve. I guess that I better call my insurance before my surgery to confirm my overnight stay, I certainly will not pay out of my pocket! I have BCBS of MA If you go to a new Dr. all of your records should transfer if the testing wasn't to long ago.  Best Wishes!

I'm really sad for the way things have gone for you, but am glad that you are keeping "everything for a reason" in your mind.  I think first off, I'd say, is Lapband something that you really want?  If so, don't switch procedures just because of the surgeon's requirements.  Secondly, if you don't mind RNY, would you consider going to Dr, Harris again?  I know he's a really good Dr., but sounds like you didn't have a good experience there.  There are many other good ones out there that will be happy to take you, don't accept anything but the best treatment-whomever that will be.  Is traveling something you can do????  I had my band done in Chlt.  It's a ride but Harris wasn't doing bands then, so I didn't have much of a choice but to drive somewhere.  I think I'd decide what type of surgery I really want, and stick with it.  Call your insurance co. and find out whom they will allow you to go to.  You may have to do a bit of driving, but it will be worth it to have someone you feel is giving you the service you deserve.  Hang in there and keep us posted, and we'd love to meet you at beans next month! Nancy

Soryy to hear about your troubles. If you like Dr Harris see if you can get him to do a 23 observations and not a true overnight stay. Dr Voellinger only makes you stay overnight for the band if you have a condition that needs to be watched and at that he normally just does a 23 hour. BCBS of NC will approve that becuase it's considered outpatient. Then if something happens the hospital will get the approval for the overnight stay. So see the doctor gets what he wants and you get approval. :-)  I hope this helps.... I don't know anyother doctors in your area but I know Dr Voellinger, Dr Lowe, Dr Gersin (might be spelled wrong) and Dr Bauman all do them here in the Charlotte area but the key to the band is great follow and in the begining it might take a few trips to the doctor to get the right fill level.  Good Luck in getting your band!!!!!!!

Hi Pearl, It's good to hear from you again.  Gosh, I am so sorry for your frustrations!  I would be too.  I think the 23 hour observation suggestion is a good one, but I would also have reservations about working with Dr Harris if I didn't feel he was entirely in my corner.  You may want to do a little more research.  Did BCBS suggest another surgeon who would meet their requirements?  It's tough when the insurance companies insist on protocols that the surgeons don't feel is in the best interests of their patients and I am sure that is why Dr Harris has this requirement.  As I have said often before, this insurance approval process is the most difficult part of this journey.  Whatever happens, I am certain it will all be for the best and I certainly hope you find your solution soon.  Please keep us posted!

I prefer most to go with the Lap Band.  The issue is I just have high blood pressure, which is more low than high and acid reflux.  That's it really.  So they really don't see the need for me to stay. I would not mind going back to Dr. Harris if I had not of have had those experiences.  Which he may truly not know the things that some of his staff members are doing.  But obviously, he is the final judge.  For them to be brushing it off like it is nothing after I have spent much time and money is what pissed me off. I know they don't have any control over the insurance, but they really failed to send all the supporting documents which also contributed.  The letter I received from BCBS stated that "they will not make decisions simply based on what the doctor or patient prefer".  The nurse claimed that they had argued with the insurance and just "don't want to deal with it".   I could not believe me ears when I heard what the nurse was saying.  It was really unprofessional!  I don't mind driving providing I get what I deserve.  Kisha

((KISHA))))

My girl!!! I just wrote and sent you a pm I am glad you have not given up and Im hoping only for the best for you sweetie.

hugs,
Darcie

I would recommend that you get the procedure that YOU want.  If you want lap band, then you should have lap band and not "settle" for another procedure.  I say this as an RNY patient, who is very happy she chose RNY, and I'm an advocate for the RNY, however I think that you have to do what you feel is right for YOU, and if you would prefer to have the lap band then I think that is what you should try to do for yourself.  Otherwise, you might feel "cheated" in the longrun.  I hope that makes sense.  I don't know Dr. Harris, but I do know Drs. Bauman and Pirrello in Concord.  They operate at a Bariatric Center of Excellence (CMC-Northeast in Concord), and I also happen to be a nurse on the unit that their patients recover on.  Most of our lap band patients go home the day of surgery, provided there are no complications (which is an EXTREMELY rare occurrence in my experience).  They both perform lap band as well as RNY, both banded and non-banded, and Dr. Pirrello also performs the gastric sleeve.  If you choose not to return to Dr. Harris and don't mind traveling to Concord, then I highly recommend both of these surgeons both from the patient point of view AND the nurse point of view.   I would hesitate to have any procedure performed by a physician who has not performed a few hundred of them, personally.  Not just weight loss procedures, but any surgical procedure.  I know they have to learn somewhere, but I wouldn't want to be a learning experience for anyone.