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Henry Buchwald M.D., Ph.D.
Loved Dr. B...hopefully I'll be approved by insurance and have this surgery.
Latest Surgery Support Comments

  • Comment by Frvsnt O. on 4/7/04 8:15 am
    Happy 4 Year Re-birthday to you!!! I found this quote and just love it! When running up a hill, it’s alright to give up as many times as you wish – as long as your feet keep moving. By - Shoma Morita M.D. I can only imagine that your pas few years have been wonderful. Full of changes and new experiences. I can hardly wait to see what I look like and feel like when I reach your spot!!! Congratulations to YOU!!! RNY 10/31/03 down 85 pounds!!!
  • Comment by Judi W. on 4/7/02 9:56 am
    Karla~~ Congratulations on your 2 yr. Anniversary!! You Look Fabulous! Hope your journey continues to bring you joy and good health. Hope you post on your profile...you are an inspiration to us.
  • Comment by Cinna G. on 4/7/02 6:07 am
    Happy TWO year anniversary to you. WOW, you were pretty in your pre-op picture. In your post-op picture you are even prettier. How are you doing? Please don’t forget to keep your profile updated so that others can travel along on this amazing journey. Have a wonderful anniversary day.
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Karla H.'s Blog
Karla H.'s Blog


May 2010
on May 26, 2010 4:19 pm

Had LapBand in Sept 2008 and lost about 20 pounds.

I'm now back up to 245....thinking about sending an application to the biggest loser.

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02/26/08
on March 9, 2008 7:53 pm
I was denied by insurance saying that DS was an investigative procedure.

OK I found out more about my insurance.....below is from my Premera BCBS policy:
 
Coverage is provided for services and supplies for the surgical treatment of obesity. Benefits are available to you and your enrolled spouse/same-sex domestic partner (SSDP) when the following criteria are met:
  • Failed dietary and lifestyle change programs.
  • Body Mass Index (BMI) greater than 40 kilograms (kg) per square meter (m2) or BMI greater than 35 kg per m2 in conjunction with severe co-morbidities. Examples of co-morbidities include cardiopulmonary complications, severe diabetes, hypertension, or obstructive sleep apnea. 
  • To qualify for benefits, the procedure must be a gastric restrictive procedure listed as medically necessary in the Premera Medical Policy on Surgery for Morbid Obesity.
__,The key words in my policy is "gastric restrictive procedure" which includes:
 
1. Vertical Banded Gastroplasty – CPT Code 43842
2. Adjustable Gastric Banding – CPT Code 43770 (Laparoscopy, surgical, gastricrestrictive procedure; placement of adjustable gastric band)
3. Open Gastric Bypass – CPT Code 43846 (gastric restrictive procedure, with gastric bypass for morbid obesity, with short limb [150 cm or less] Roux-en-Ygastroenterostomy)
4. Laparoscopic Gastric Bypass – CPT Code 43644 (laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy(roux limb 150 cm or less)
5. Mini-Gastric Bypass – No Specific CPT Code
6. Sleeve Gastrectomy – No Specific CPT Code
 
It does not cover any malabsorbtive procedures.

Another person on the OH DS Forum has the same insurance and when denied was told it was because it was investigative surgery....but it turned out that she was denied on all her appeals because our insurance does not cover the malabsorbtive procedures.....so I will try to appeal and keep my fingers crossed but it looks like if I want this procedure it will have to be self pay.
 
BUMMER......
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02/12/08
on February 12, 2008 12:24 pm
Danette and Dr. Buchwald were on vacation last week so she has not called me back with information from my insurance company yet.  I called her yesterday and she is supposed to be calling me back.
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02/02/08
on February 2, 2008 5:47 pm
Finally spoke to Dr. B.  He said it looks like I should have surgery.  I spoke with Danette and she is checking to see what my insurance needs.  I've already done testing and gotten letters from my PCP.  Plus supplied a notebook of information.  Hopefully it will go easily from here.
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01/20/08
on January 20, 2008 9:10 pm
Haven't written in a while...finally got my upper GI and endoscopy.  I'm trying to get phone consult with Dr. Buchwald once he reviews my results.  Danette is getting my records and talking to Dr. B...then will call me back.
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My Story

I'm 45 and have been married 17 years.  I have a daughter (20) who is attending University of North Texas and a son (16) who is a sophmore in high school. 

Growing up I was always a little heavier then others my age...not fat just chubby.  After having my second child my weight started going up.  I joined weight watchers for 1 1/2 years and lost 40 pounds, but gained it back and more.  After that I just did the yo-yo diet game.  I gained to my all time high weight of 265.  I decided to have RNY in 1999...my surgery was April 2000.

My weight loss was slow but with watching my diet and working out I got down to 143....maybe for a week.  My weight slowly started climbing.  By Oct 2004 I weight 183.  I found out I had a brain aneurysm and had brain surgery.  I was in and out of test for a year...I was supposed to have a stent put in Oct 2005 but the surgery was cancelled.  Instead I went for a mammogram.  I had breast cancer.  I want through chemo, lumpectomy, radiation and a year of followup infusion....finally finished Jan 2007.  No more cancer but went into early menopause.  I had very little activity during the last 2 1/2 years...was not allowed to do anything by my family and doctors.  So my weight skyrocketed.