Leeann from NY? Can I ask you ??"S

Hello, I have been researching WLS since last summer. I thought I had settled for the RNY until I found out just this week about the DS! I am in Albany, Ny and am looking for a surgeon for DS. I was already heading to Westchester for the RNY, so the city isn't much further. Anyway, I was hoping I could maybe email you a bit and get some opinions about DR. Gagner, who sounds fantastic. I am slightly concerned 1. that he may not accept my insurance and 2) that my bmi is too low. I have a 41-42 BMI, asthma, borderline hPB, plus a huge family history of obesity sicknesses. Hope I am not bothering you? Carolyn

Carolyn, Absolutely! Better than email, you can call me. Email me and I'll reply with my number. Dr. G is fantastic. BMI is not an issue, you are over 40. Insurance is compliacted but I explain it all to you Lee

Carolyn, Welcome to the DS forum! There are a few others here who've already had surgery with Dr. Gagner, as well. I'm scheduled to have a DS with him on 9/21. I had been researching since last summer, and would have had my surgery by early '05 if I hadn't gotten 'sidetracked' by thyroid cancer. LeeAnn's right - the insurance thing is complicated..... pretty much, he doesn't take any insurance! If you have out of network benefits, then you may have some coverage, but you'll still be responsible for the difference between what the insurance considers customary and reasonable for NYC, and what Dr. Gagner expects as payment ($15,000). Good luck! Beth (24 days and counting....)

Welcome to the DS board. Your BMI shouldn't be a problem - if you qualify for WLS at all, then you have a high enough BMI for the DS. Insurance on the other hand can be complicated. I'm avoiding the whole insurance battle by going self-pay, but not everyone has that option. I, too, had learned about the RNY years ago, and always put off considering WLS because of certain issues I had with it. The minute I heard about the DS I was sold on it. Then I discovered I was in for a fight when it came to my local surgeons. One is better than the other, but neither of them are really pro-DS. I would have had to travel regardless, but I'm headed to Brazil for mine in about two weeks. Not everyone has to travel as far as me for surgery, but I think it's worth it. So how did you learn about the DS? How long have you been on OH? I noticed your profile doesn't have a lot of info, so that's why I ask. What are the obesity related illnesses your family has? Any info you need, just ask - someone here will have an answer, and if they don't, they support you while you find one.

Hi, Carolyn! Welcome to the DS board. Good luck on your journey. Jeanie

Hello all, wow, you guys are so much more friendly than the main board. Basically, I know I qualitfy for the surgery (RNY) my pcpc was fine with referring me. I called my insurance company and they said they will cover the procedure if you have a doctor who explains why you need it. So, I am a little nervous about how Dr. Gagner's payment works. I have Blueshield of NorthEastern NY, it's an indemnity plan and I can see any doctor I chose in or out of network. How does that fit in with DR. Gagner? My profile is a little sparse partly because I spend so much time reading all of your profiles and discussions, and partly because I don't get how to add things. Here is my brief info: I have been obese since I was little. I have been on every diet plan, tried all the new exercise equiptment, joined gyms, well you all kow how it goes. I lost 70 pouinds 3 years ago on Weigh****chers, My all time high was 260. I gained back 40 of it, and made my decision on WLS. PLus my older sister had an RNY about a month and a half ago. She sold me on it, I didn't know about the DS yet. My mother has type 2 diabetes, hbp, arthritis, barrett's esophagus, she is obese. She has many other health problems. My two older sister's have many of the same issues as well. My older brother does too. My father's family has a history of stroke and HBP, as well as colon cancer. I know just know this is the path I am heading towards. Anyway, this is me. I am a 30 yr old, middle school teacher. I want to be able to stand in front of my class all day without getting knee pains and back pains. So I will call DR. Gagner's office in the morning and see what to do next. I would really love to have surgery over my Christmas break, but I can wait if need be. How long were you all out of work for? Thanks again!!

Friendly? Sssssshhhhh *laugh* You're going to ruin our reputations. (But thank you!) The standard quote is "3 to 6 weeks". I would think with you being on your feet all day, you'll probably want the longer time, because even though you may be pain-free at 3 weeks, you will still be easily exhausted. There have been a few people (especially those who have no paid time off) who went back sooner, but they would have taken more time if they could have afforded it. To update your profile, at the top of the messageboard screen here, you'll see a bunch of tiny blue links. One of them says "Your profile" It will take you to a page with a cartoon scale and a bunch more links. One of them says "General Info". There are other links there too which update info, including one on your surgeon, and on your insurance. But the main body is "General Info". And if you want a "spruced up" profile, one of the gurus here can do that for you, putting all kinds of pretty HTML in there.

Carolyn, You're 30?? You look like a teenager in your picture! Dr. Gagner is asking for $4,000 up front (from me) just in case the insurance company doesn't come close to what he expects as his fee. I still have to sign a form that says I will cover the difference between what the ins. pays and his fee. I wonder if there's a "threshold" that he waives fees over - in other words, if he were that concerned about getting the entire amount, wouldn't he ask for the full $15,000 up front, and let the patient wait for reimbursement? Not that I'm counting on that, but a girl can hope, right? I had my initial consult on June 23rd, and moved somewhat slowly on getting all my stuff done. I'm scheduled for surgery on 9/21 - so that's three months from "start to finish", though it's more like "start to start". If you get a consultation appointment sometime in the next month, and move immediately on getting pre-reqs scheduled and done, you should be able to have surgery by your Christmas break - barring any push-back from your insurance. As far as the "out of work" recuperation phase..... now THAT'S scaring me! I'm an almost 46 year old stay at home mom with a 2 1/2 year old. While I know I can't hit the ground running after surgery, I don't know just how I'm going to manage for 8 weeks with not lifting her at all. I may need to hire help, since my husband will have to go back to work right away. That could potentially be the most expensive part of this procedure for me! Beth 23 days and counting

There are many instances when Dr. Gagners office will work with patients on the "up-front fee". Dr. Pomp and Dr. Dakin also work with Dr. Gagner and they work with insurance companies routinely. Dr. Dakin does not perform the DS however Dr. Pomp does and Dr. Gagner assists in every case, to my knowledge. I don't believe that Dr. Pomp requires an "up-front fee", however I am a patient of Dr. Gagner and I didn't pay any out of pocket expenses to Dr. Gagner's office. (Unless you count Liz - program nutritionist - who does not participate with insurance comapnies at all. Reimbursement for her fee through your insurance company is totally possible, with the approval for surgery. Lee

dr g put the payment fee requirement in place after your surgery, and they have decided no waivers, even though i was promise before hand. If he doesnt accept the tricare offer. i guess i will be going to lenox hill.