Orlando?

I'm in Orlando. Just starting to research. I have Medicare only. I'd love to talk to anyone else in the Orlando area that has had the surgery and has dealt with Medicare. Good? Bad?

Welcome, you are starting in the right place.  Which surg are you having?  All I can tell you is research the surg you are interested in. Don't take one persons word on an issue either. 

Everyone will say their surgeon is the best.   Go to the surgeon patient  seminars re-ask all your questions there.


Good luck starting your journey.

The trick is going to be finding a surgeon that has the Center of Excellence status and takes medicare.  Just because they have the COE designation -- does not mean they accept medicare.  You can find a list of facilities that have the Center of Excellence status -- that do accept medicare on the Medicare website.  http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.as p#TopOfPage

You can find a list of surgeons and facilities that have the Center of Excellence status on the ASBS website.  Just remember many (if not most) on this list do not accept Medicare.  http://www.surgicalreview.org/locate.aspx

The good news is that there is no pre-authorization needed for medicare.  As long as you meet the criteria and the hospital and surgeon have the COE you are good to go.  The bad news is that you are probably going to have to go out of the Orlando area to find a hospital and doctor with the COE.  But hey, Tampa is only a $10 train ride away.

Red

Well, I just got off the phone with the Administrative Specialist for the Bariatric Program at Celebration Health. She personally called the office of Dr. Kim and AS OF THIS WEEK, he is accepting straight Medicare! I'm going to the informational seminar next Wednesday. I wish I had known about this yesterday, I would have gone to last nights session. This really is only my second day of research regarding WLS for the past 4 years. Before I was on disability, I tried to get approved for it through Cigna. I jumped through their hoops for 8 months before they denied me because my doctor hadn't kept accurate records (in THEIR opinion) about my weight loss attempts.

When I spoke to Medicare yesterday, they told me that they cover three methods of WLS, the RNY, the LAP and something called Biliopancreatic Diversion w/duodenal switch. I know that the RNY is I guess the "old school" method but still very effective. I've heard that the LAP method doesn't work as well and I know nothing at all about the third. Everyone I talk to seems to have had a different method. One friend had a "mini-gastric bypass" and lost a TON of weight. Another friend had the "sleeve" method, also via Dr. Kim, but I guess Medicare doesn't cover either of those methods. I've also heard rumours that you have to lose weight before you have the surgery? Right now, I'm sitting right at around 400 pounds, and I'm 5' 10" with a large frame. There was a time that I lost a bunch of weight and got down to about 195 and people said I looked "gaunt", so I guess I can carry more than most women.

I hope to make some friends on here. I'm going to need it!

I am from the Orlando area. I would like us to stay connected. I am currently going through my 6 month diet and I will be done July 1st. I wish you luck!!!!

I'm really SO brand new at this...what is the 6 month diet?

Hi, Plennon,
How is your research going about wls? I just had my surgery on June 8th 2009. I have lost 23 lbs since . I had lost 16 before surgery.The RNY is not considered the "old school" method. It is the " Gold Standard " of the operations. They will put you on a two week liquid diet before surgery to lose weight. This is to shrink your liver. If your liver is to large they will have to open you up for surgery. If the liver shrinks than dr. kim can do it laproscopally. Dont know if I spelled that right. Anyways Dr. Kim is a wonderful doctor. Good Luck to you on your journey
Darlene

I had my band surgery with Dr. Kim on 6/1.  I don't have medicare, but I did talk to them about the requirements for a family member.  I was told it's generally a 6 month monitored diet.  My understanding is that your PCP monitors that diet.  I don't think a specific diet is required - just the time frame - meaning if you did WW or Am. Heart Assoc etc it would be fine - just needs to be monitored.  You're definitely in the right place - Dr. Kim's office is the place to be and he did just start accepting it.  He doesn't do the switch - just the sleeve, band and RNY.  The sleeve is still considered "new" and not covered by any insurance.  I spoke with Dr. Kim about the RNY vs the band and he said in his experience the long term outcomes were similar so he didn't see a benefit for me of one surgery over the other - in the end I chose the band.  You should attend the open meeting as well - it's a good place to meet people in all stages and with all surgeries.  You will be required to have a psych consult with Dr. Kerry Ferguson - must be with her.  It's $600 payable up front - she will give you paperwork to submit to your insurance.  Mine wouldn't cover any of it Medicare might.  You'll likely also need a cardiology clearance.  There's bloodwork involved, chest x-ray and you may need a clearance from a pulmonologist as well. 

Honestly so far I'm rather impressed with the surgery and the surgeon.  Dr. Kim did an EXCELLENT job.  I was able to have the single incision method - which means I have a belly button incision which shouldn't be visible and one small incision center chest at the bra line...  Beautiful work. 

I'm able to eat anything really at this point - not sure if that's good or bad...  ;)  I haven't eaten junk - was on liquids for 2 weeks after...  I'm on a 3 week phase now of adding foods - after that I have an appointment and will have my first fill.  Honestly I think I could do that now...  I haven't been having any issues whatsoever.  The great thing though is that I eat 4-5 oz of food and I AM full - I'm not stuffed, but I'm satiated.  I mean that's just WEIRD!!  LOL  I also stay fuller longer...  So far so good...  I am still anxious though...

Good luck with this and I'm glad to find some other "neighbors"  :)

"You will be required to have a psych consult with Dr. Kerry Ferguson - must be with her.  It's $600 payable up front - she will give you paperwork to submit to your insurance"

Well oh no.  :(  I was going to head to one of the informational sessions and start the process since my insurance (Disney Cigna through my husband) just kicked in, but honestly this is something I just cannot afford.  I don't have 600 dollars to just plop down up front.  :(  I have been dreaming of this surgery for about 7 years now, and I finally had the insurance to do it and now I'm feeling kind of crushed that it's likely never going to happen just because I can't afford the psych consult.  I'm really sick of being over 400 pounds.

Are you in OH or FL?  Different surgeons have different requirements.   I'm sure not all require just one therapist do the eval.  I have to admit I wasn't happy with that at all - it seems utterly ridiculous since I could have just gone to another therapist and paid the co-pay.  She's quite nice though and has been through a bypass herself - so that's a bonus.  Dr. Kim is an excellent surgeon.  I don't know your situation, but you could probably put  it on a card and then submit to your insurance.  I guess you could call and see if she participates with anyone.  I know a patient was in one of my classes who had the surgery with another Dr a couple years ago.  She wanted Dr. Kim to give her fills - even she had to go through the psych eval...  So, I don't think he'd make an exception.   I would still go to the info session - it's well worth attending.  Also, your insurance may require you to do a pre-op diet -if so you could save for the eval during that time as well as any copays you may have.  My surgery cost me about $1300 and that was a lot for us, but well worth it.  It would have been $1100 (hospital and surgery copays as well as the psych eval), but I had to have a cardiology clearance - long story short I ended up with a bunch of testing and the copays on that cost me about $200 - bulk of it was for the heart cath - which was perfect BTW.  Dr. Kim had nothing to do with my selection of cardiologist - I picked him...    You can also attend the monthly meeting - it's a good place to meet people who have had diffrerent surgeries.  If you go let me know - I'd love to say hi.  :)