ANuChance; I came across your post and I am in network. There are no upfront fees from the surgical office. The bariatric center does have a one time fee of upto $250 which covers the nutritionist and bariatric mental health eval. After that, everything is billed to your insurance and you are just responsible for copays and deductables which is the same as seeing any other doctor. We have never had anything like the huge fees charged at other programs. David Geller, MD Medical Director Norton Suburban Hospital Bariatric Surgery Program Bariatric Surgeons ok Kentuckiana 4001 Dutchmans Lane, Suite 1E Louisville, KY 40207 (502) 893-7151, fax 893-7020 dr.geller@insightbb.com

Lydia, the way I would handle it is to perform your gallbladder surgery first since you are having symptoms from that. I too, would not perform gallbladder and lap-band surgery at the same operation for fear of infection. David Geller, MD Bariatric Surgeons of Kentuckiana Medical Director Norton Suburban Bariatric Surgery Program 4001 Dutchmans Lane, 1E Louisville, KY 40207 (502) 893-7151

Theresa, Keep up the fight. Any luck with your employer? I do participate in-network in most insurance plans. What that means is a patient is responsible for their copays at each office visit and their deductable. Many patients only pay copays and have no additional costs because their deductable has already been met. With any surgery and any size deductable (even big deductables), you can be pretty sure you will meet the deductable for that year. If you go with an out-of-network physician, most times there is an additional out-of-network deductable and an in-network deductable with your insurance in addition to whatever fees the out-of-network physician chooses to charge. Let me give an example; If the charge for something is $10,000, and the insurance pays the in-network doctor $500 and says that is the allowable, then that is all the in-network doctor gets. The out-of-network doctor may get the same $500 from the insurance, but the patient may be responsible for the entire difference or $9,500 in this example. The reason for this potentially large extra cost to the patient is that the out-of-network doctor has no contract with the insurance company to limit the reimbursement. Where the in-network doctor does have a contract with the insurance company and has already 'agreed' to accept what the insurance company pays. I know this is a very confusing topic and even after running my own practice, I still have a lot to learn. I feel patients need to inform themselves of these issues ahead of time, so there are no financial surprises down the road. I hope this answers the questions. David Geller, MD Bariatric Surgeons of Kentuckiana Medical Director Norton Suburban Bariatric Surgery Program 4001 Dutchmans Lane, Suite 1E Louisville, KY 40207 (502) 893-7151

There is a medicine -- called DEVROM. This is used alot in the BPD-DS (biliopancreatic diversion-duodenal switch) population and not as much in gastric bypass patients. It shouldn't be an issue at all with Lap-Band patients. Basically it is a bowel deoderant. It doesn't reduce the amount of gas, it is supposed to cover up the odor. I have only seen it online. We used to have a few samples, but not anymore. I include the web link below. Good luck!!! Also, you may need to avoid certain foods -- the same foods colostomy patients should avoid. You may get more air in your system if you chew gum, talk fast, or drink thru a straw. With gastric bypass and band surgery, once the air is in your stomach, it has to go thru your whole GI tract and your not likely to be able to burp it out. http://www.devrom.com/devrom.asp David Geller, MD 4001 Dutchmans Lane, 1E Louisville, KY 40207 (502) 893-7151, fax 893-7020

are you looking for a job? i will see you later this week. David Geller, MD 502-893-7151, FAX 502-893-7020

Sharee, Hang in there! I know Norton's dowton is very along in the process to getting the COE. Site visit was done a while ago so they are waiting for their final approval. I operate at Norton Suburban hospital and we are far into the process as well. David Geller, MD

Kathy, The support groups are still the 4th Tuesday of each month at 730pm at Suburban Hospital in Plaza III. There is an informational seminar at 600pm at the same location. This coming Tuesday the 22nd, I will be presenting the informational seminar. Norton Hospital downtown, also has regular support groups the 2nd Tuesday of each month at the Norton Pavillion building on Broadway. Please call for more information. David Geller, MD 502-893-7151

I will look for you there. For Humana, many plans require 6 months of doctor supervised weight loss and we can with getting that set up. David Geller, MD 502-893-7151, fax 502-893-7020

Angela, thanks for the comments. However, there have been some changes. RIGHTWEIGH has been terminated by the hospital and no longer represents the surgeons at the hospital. The NORTON BARIATRIC CENTER is taking over all of the functions that RightWeigh had performed. I am excited with this change as we will be able to provide an even more comprehensive service to patients than we could when associated with RightWeigh. I have been performing the Lap-Band for 2 years now and in recent review of my data, it makes up about 50% of my practice and the rest are laparoscopic gastic bypasses. Dr. Shina is getting ready to start doing bands. The first step in the process is to come to a free seminar. This is a little different than the way it was done last year. But the new process is much better and more efficient. Call or email my office and we can refer you to register for the free informational seminar. David Geller, MD 502-893-7151 dr.geller@insightbb.com

I'll see you thursday. My office does not collect any fees except insurance copays and any deductable that may be assigned. One program requirement is that you see the nutritionist. By the time of surgery you will need to see the nutritionist twice, at $80.00 each. The first is for the nutritionist evaluation which is also a requirement of the insurance. The second visit with the nutritionist comes 2 to 3 weeks before surgery in the form of a PAC (pre-admission counseling) which is a nutrionist led group class which goes into great detail of what to expect before and after surgery. I hope this helps clear that up. My office does not have any fees. David Geller, MD

In the country, so far, there are only about 110 COE by the American Society for Bariatric Surgery or SRC and only 1 in KY in Lexington. The American College of Surgeons also will be providing a COE (Center of Excellence) certification that will be accepted by Medicare, but they have not assigned any so far. At Norton Hospitals in Louisville, the process has been started, just not completed. We have long awaited the Medicare announcement that came 2-21-06, and are happy that Medicare is expanding coverage to include the Lap-Band, but also their guidelines will be more in line with the NIH guidelines. What was a surprise, because it wasn't noted on any previous releases, was that Medicare would require COE certification. An even bigger surprise was that the policy that was released for the first time on 2-21-06 went into effect on 2-21-06. Therefore, all Medicare insured bariatric surgeries in the country will not be covered until each center meets the COE criteria. We are expecting to have this resolved in a few weeks. I hope this clears up the confusion. David Geller, MD

What Support Group (public welcome) When 08/24/04, 7:30 PM Where Louisville, KY Address Norton Suburban Hospital Directions IN First Floor Classroom, just two rooms down from main entrance. Free parking in any garage or outside. Description August support Group: LIFE AFTER WEIGHT LOSS. A plastic surgeon experienced in post-gastric bypass surgery will be on hand to discuss plastic surgeries. Also, we'll present other services through this new program that complements the bariatric program...including intensive aftercare workshops available on a bi-weekly basis, led by a qualified group leader. And, low-cost tummy tuck options at Norton Suburban will be discussed. Any ideas or requests for services through the LIFE AFTER WEIGHT LOSS CENTER are welcome. Bring them in person, or e-mail us at rick@rightweigh.com Contact Phone 502-899-6721

What Educational Meeting When 08/24/04, 6:00 PM Where Louisville, KY Address Norton Suburban Hospital Directions Meeting in First Floor Classroom in main hospital building Description Free seminar on bariatric surgery (LAP BAND, LAPAROSCOPIC GASTRIC BYPASS, OPEN GASTRIC BYPASS), Risks, benefits, and lifestyle requirements. Monthly support group of bariatric patients follows this meeting, so stay on and meet some people who have already had bariatric surgery. Contact Phone 502-899-6724