Dr. Keilin left her thoughts on a guest post on LapBandDoctors.com

Here are some excerpts from the email I received from Allergan:

Enter the Voice My C.H.O.I.C.E. Contest Program
This contest is for LAP-BAND® System patients. To enter the contest, which runs from May 12 through July 27, simply submit a short essay or video at www.LapbandChoiceContest.com about your weight-loss journey and how your choice to overcome your struggle with weight has changed your life.

Twelve winners will be given the opportunity to go on a 3-day/2-night trip to Washington, D.C. in September to share their personal stories with legislators and media. Allergan, Inc., will cover travel-related expenses for winners and a guest. More information regarding the contest, including rules and eligibility, can be accessed at www.LapbandChoiceContest.com.

Sign our Petition to Congress
Sign the online petition to Congress at www.mychoicecampaign.com to tell Congress it’s time to recognize obesity as a disease, NOT a choice, to focus on prevention and treatment, and to accept all treatments, including weight-loss surgery for those 100 pounds or more overweight. The petition will be delivered to legislators in September by the winners of our contest. We need your support to reach our goal of 250,000 signatures – that’s one signature for every dollar that Allergan, Inc., will donate to The George Washington University School of Public Health and Health Services’ Department of Health to support research on obesity through the Strategies to Overcome and Prevent (STOP) Obesity Alliance. The STOP Obesity Alliance is helping to change how we perceive and approach the problem of obesity, overweight, and weight-related health risks, including heart disease and diabetes.

Join our Facebook Cause Page and Follow us on Twitter
Join the campaign Cause page on Facebook – www.mychoicecampaign.com/facebook – to help you spread the word about the campaign and encourage your friends to join our movement.

We haven’t forgotten the blog or forgotten the patients that read it. In fact we continue to answer questions on blog posts. In the past few weeks we have had people from New York and other states far away from our practice in Texas, that have found the blog and found the content useful.

So why haven’t we written anything new? Well we are at work with a group of doctors on an exciting new project and a new website. There are Lap Band surgeons around the country that we are teaming up with to offer patients a place to get news and information on Lap Bands from a variety of Lap Band surgeons around the country.

It looks like this project will be complete within the next few months after we get together at the annual meeting of the American Society of Bariatric Surgery, which is at the end of June. Until then we and other surgeons are adding a few posts to that site so it will have some content when people turn to it.

Until then, our blog posts on http://blog.noscales.com will slow down, and we anticipate about one post a week. Remember that we have a few years’ worth of posts, so even if it not “new”, it may be “new to you!” Take a look at the Archives on the blog, we have posts from 3 years ago! Just because a blog post is old, doesn’t mean it won’t have information that is not new or relevant to you. As always, any questions you have, post them on the blog post, and we will be happy to answer them.

So stay tuned, and no we haven’t forgotten about you.

Dr. Hekier and Dr. Keilin

Together with the multiple emails and phone calls I have made, and the pressure from emails and phone calls from concerned patients, Blue Cross Blue Shield has extended the deadline for Wadley’s designation as a Bariatric Center of Distinction for 2 more weeks until March 12. They have indicated via email that they will review the situation, but have not allowed us to participate in the debate or review process.

We remain concerned that despite this 2-week reprieve, they might remove the Center of Distinction designation on March 12, and thereby deny access to care for many of our patients.

I urge you to email and call the representatives below. They are the ones that I have found are most involved in the decision process.

Dr. Carole Flamm
Executive Medical Director Office of Clinical Affairs Blue Cross and Blue Shield Association
312-297-5905
Carole.FLAMM@bcbsa.com

Dr. Allan Chernov
Blue Cross Blue Shield of Texas Medical Director
allan.chernov@bcbstx.com
972-766-1149

Are you nervous about talking to an insurance company employee? You shouldn’t be, but if you are, send them an email. Or call them after hours to leave a message on their voice mail. If those insurance company employees come to the office in the morning and get dozens of emails or voice mails from people upset with their arbitrary decision to deny access to care, it will get their attention. The fact that they gave us a 2-week extension means that we have their attention.

There is a LapBand patient and advocate on Facebook named Cher Lewis who lives in Dallas who is sympathetic to our cause. She invited me to be a guest on her Internet Radio talk show to discuss this issue because she sees this as a dangerous trend towards the denial of access to care by an insurance company. I’m glad to see that someone outside of Texarkana has taken a stand on this issue, and I urge you to do the same.

This is not only a health issue, it is a consumer protection issue. Each year insurance companies raise their premiums at a painful rate. I know this personally, because in our office we doctors pay for Blue Cross of Texas policies for our families and our employees. Each year we pay higher and higher premiums. Yet as doctors we generally get the same or less each year for the same procedures or office visits. So where does this money go? It goes right into the pockets of insurance companies.

Don’t let them get away with this. Be creative. Use Facebook, MySpace, and Twitter and enlist others in your cause. Get people in your church and workplace to call.

Even if this doesn’t affect you directly now, it might in the future. If today an insurance company doesn’t allow you to get bariatric surgery, what will stop them from denying other care for any other medical problem in the future? Let’s make a stand together, because together we can show the insurance companies they work for us, not the other way around.

Regards,
Dr. Ron Hekier

PS Later today I will send out a lengthy email explaining the history of the Center of Excellence centers and what it means for the future of healthcare in this country.

We have established and been designated a Blue Cross Blue Shield Bariatric Center of Distinction for several years and were stunned to hear this news.

What was their reason?  They said they only mean to certify centers that provide gastric bypass in addition to Lap Bands.  They said that it was a mistake to certify us in the first place, and somehow they “overlooked” the fact that we did not perform gastric bypass for all these years.

This is difficult to believe.  When we applied for the the Center of Distinction we provided Blue Cross Blue Shield with all of our operative data which clearly shows that we perform Lap Bands only.  This is a decision we have chosen voluntarily since the safety profile is so much higher with a Lap Band than with the gastric bypass which requires cutting and stapling the stomach and instestines.  So they knew that up front.  Additionally, every 3 months for the past few years, we have provided our data to Blue Cross Blue Shield, which clearly shows that we are not performing gastric bypass.

What this means is that those patients who have a policy with Blue Cross that requires a Center of Distinction, which for our patients includes Blue Cross Texas TRS (for teachers), Blue Cross Illinois, and Anthem Blue Cross, they will lose the ability to have Lap Band surgery in Texarkana and have care in Texarkana for bariatric related procedures as of next Friday if the situation holds.

The nearest Bariatric Centers for Distinction are in the Dallas area and Tyler area.  There are none in the whole State of Arkansas and the closest in Louisiana is way down in southern Louisiana.

I personally spent 3 days trying to reach someone who would listen to me.  I was out of town when the message first arrived a week ago Friday, and when I got back to the office on Tuesday I immediately took action.  I first called the Blue Cross Texas rep in Dallas, Celeste Stewart, but she said she had no say in the matter and gave me contact info for a rep in Chicago with Blue Cross Blue Shield, named Wendy Marinkovich.  Ms. Marinkovich said I would need to talk to the Executive Medical Director, Dr. Carol Flamm, but refused to give me her phone number or email! On Tuesday, Ms. Marinkovich took my number and said Dr. Flamm would call me back.

In the meantime someone not connected with Blue Cross gave me the number for Dr. Allan Chernov, the Medical Director for Texas.  I called him and got his administrative assistant.  They took down my name and number but I never heard from him.

Wednesday, Thursday, and Friday, I made many phone calls and sent emails trying to reach someone.  I still couldn’t even get the contact info for the Executive Medical Director in Chicago, Dr. Carole Flamm, because they refused to get me her contact info.  Luckily, on Friday I was able to find her phone number and email on the Internet.  After leaving her a voice mail, and sending more emails to Ms. Stewart, Ms. Marinokivch, and Dr. Flamm asking that they please call me, I finally heard from Carole Flamm, MD at about 5:30 PM Friday.

We had a lengthy conversation, but she essentially said there was nothing she would do, and the decision to remove our designation as a Center of Distinction would not be reversed.

My personal opinion is that this is all a matter of Blue Cross Blue Shield trying to make more money, and keep their policy holders from getting the medical benefits they are entitled to.

Here is a story I told Dr. Flamm which shows Blue Cross Blue Shield behavior of placing money over a patient’s health:

Back in 2007, my surgical partner, Dr. Keilin and I attended a conference entitled “Building & Managing Bariatric Surgery Centers of Excellence.”  One of the speakers was Dr. Michael-Anne Browne, at the time the Regional Medical Director for
Network Medical Management for Blue Shield of California.  On January 23, 2007, she spoke at the conference and she was asked about the difficulty in obtaining third party payor coverage for bariatric surgery.  Her verbal response follows: “The problem with Bariatric Surgery is not that it doesn’t work.  We know it works.  The problem is that it has expensive up-front costs.  The average return on investment is 4 years.  The average Blue Shield of California client switches providers in 2 to 3 years [to another third party payor.] Therefore for every patient we approve for bariatric surgery we create a better financial risk for our competitors.”

The point of the Regional Medical Director for Network Medical Management for Blue Shield of California was clear.  Blue Shield of California will deny access to bariatric surgery to our clients for financial reasons, despite being aware of scientific medical evidence
indicating that those patients’ health will improve with access to those services.

For those of you with Anthem Blue Cross, you might have heard in the news how the White House, the Dept. of Health and Human Services, and the House of Representatives Committee of Energy and Commerce are all investigating how it is that Anthem Blue Cross in California can justify their proposed rate hikes of 39% for policyholders, when their parent company had$2.7 billion in revenue in the last quarter of 2009 alone.
For some background see:Anthem Blue Cross Internal Documents

Here in our office, we provide our employees with Texas Blue Cross Blue Shield insurance.  Each year we have seen our premiums skyrocket, and an annual rise in 20% is not uncommon.  Yet the pay from Blue Cross Blue Shield, to us doctors as health care providers, has stayed the same or dropped most years.  For those of you that have been with us for a few years, look at your EOBs.  You will see we are generally making less each year for the same office visit.  Or if you just had a Lap Band compare it with an EOB from someone who had one from a few years ago.  We are making less each year.  So where is this money from extra-premiums going?  Not to pay health care providers, but rather to the profits of the insurance industry that is supposed to be giving you the medical care you pay for.

Think about it.  For those policy holders that are paying for a service, i.e. access to medically necessary procedures including weight-loss surgery when medically necessary, they are not being given access to those services.  Sounds like thievery to me.

Who does this affect?  Directly it affects those policy holders mentioned above.  But in reality it affects all of us.  Because pretty soon, all flavors of Blue Cross Blue Shield may require surgery performed at a Center of Distinction.  Also, what is to stop any other insurance company from sending an email at a late afternoon on Friday to a doctor or facility saying they can no longer provide a service to a patient?  It is Lap Bands now, but it might breast cancer surgery, elective C-sections, spinal injections for back pain, or anything else in the future.

We applaud consumer watch dog groups watching this issue: ConsumerWatchDog.org

We must make a forceful stand now, which is why I am sending you this extraordinary message.

The typical insurance rep probably rarely hears from a doctor or patient.  Please take just a moment to leave a brief message or an email to the following people:

Celeste Stewart
Blue Cross Blue Shield of Texas Specialty Programs Manager
972-766-6829
celeste_stewart@bcbstx.com

Dr. Carole Flamm  
Executive Medical Director Office of Clinical Affairs Blue Cross and Blue Shield Association
312-297-5905
Carole.FLAMM@bcbsa.com

Dr. Allan Chernov
Blue Cross Blue Shield of Texas Medical Director
allan.chernov@bcbstx.com
972-766-1149

Wendy Marinnkovich
Manager, Network Credentialing. BlueCross BlueShield Association
wendy.marinkovich@bcbsa.com
312-297-6357

Additionally, I have another option I recommend.  My brother is currently serving on the staff for the House of Representatives Subcommittee on Commerce, Trade, and Consumer Protection.  It is the full committee, chaired by Rep. Waxman that is holding hearings on Anthem Blue Cross of California’s exorbitant proposed rate increases.  My brother pointed to me that Rep. Ralph Hall serves on one the subcommittees of that office.  He serves on the Subcommittee on Health.  Rep. Hall is the representative for many of us here in East Texas.  A map of the district he serves is shown on this website:
District 4 – Rep. Hall
Please contact Rep. Hall on this urgent issue as well.   The number for his Washington D.C. office is 202-225-6673.

For those of you who think you have no dog in this fight, let me remind you that if abuses by insurance companies are left unchallenged they eventually will effect us all.  Here in Texarkana many gynecologists no longer perform obstetrics and won’t deliver babies because of insurance and malpractice issues.  One of our neurosurgeons does not perform intracranial surgery anymore so if you have a head injury from an accident, or a ruptured intracranial aneurysm or similar brain injury on a day or night he is on call, you will quite possible die in the local ER while the Texarkana hospitals try to get you transported to another city to the care of an neurosurgeon.  There are rumors of another prominent doctor in Texarkana that may drop Blue Cross altogether because of fights they are going through to get paid on surgical procedures they have performed over the past year.

If you do nothing now, you might find yourself in the Emergency Room in the future needing care for a heart attack, stroke, appendicitis, or a whole host of problems, with no one to care for you.

I urge you:  contact the Blue Cross Blue Shield reps I have noted above.  Contact Rep. Ralph Hall.  Get the word out on Facebook, MySpace, Twitter, and any way you can.

I will not give up.  I hope you don’t as well.
Dr. Ron Hekier

Weight Loss Surgery Channel and he was gracious enough to have Dr. Keilin and I share our knowledge with his audience.  (Craig is a successful gastric bypass patient from many years ago.)  After our filming session we got to talking and Craig shared his thoughts as a weight loss surgery veteran.  He says in his support groups he asks people who have fallen off the wagon “What was your f— it moment?  At what point did you say, awww f— it, I’m going to have a pint of ice cream.  F— it, I’m going to have that Chocolate Blizzard.”

Ask yourself.  What pushed you over the edge?  Now if you are about to have a F— it moment, stop yourself.

I came very close to having one myself just now.  Some background….  I am training on my indoor rowing machine.  (For some background thoughts on this check out my post from November 2008 : http://blog.noscales.com/best-exercise-for-weight-loss-and-fitness-indoor-rowing-with-xeno-muller.html )

Well, I am planning on competing in an indoor rowing competition in Boston next month, (it’s my mid-life crisis, I just turned 40 ), so I am taking this very seriously and really watching my diet.  I don’t think I’ve had any processed food or white flour in about 3 weeks.  No snacks, nothing.

I am following a strict training plan developed for me by an Olympic champion rower (Xeno Muller from the above post) and I just think I can’t handle the program from an aerobic standpoint.  There are 3 weeks left before my competition and I am freaking out.  In a rare display of frustration, I quit my planned 40 minute row after 25 minutes.   Upset, I came into the house, looked at the fridge and considered getting some junky food.  (Luckily we don’t have too much junk food, just some stuff we allow our daughters to have.)  I came close to saying “F— it.  My exercise sucks.  I am in crappy shape.  I will never reach my goals.  I should just eat an ice cream sandwich.  F— it.”

Well I stopped myself.  Internally I told myself “You are trying to progress.  You are trying to take a step forward.  You are frustrated that you are moving forawrd as quickly as you would like, but having that ice-cream sandwhich won’t help.  It will set you backwards, and make going forwards even harder.”

So I had 3 spoonfuls of low fat cottage cheese.  After I finish this post, I will have an egg-white omelet.  Then I will go to sleep and try for a better day tomorrow.  If you find yourself saying “F— it”, stop yourself.

They said they were carrying a jar of peanut butter in their purse (!) and snacking on peanut butter throughout the entire day.  The primary reason “It tastes good.”

Yes it is true, it probably does taste good.  But that doesn’t mean it is good for you.  If I could, I would live on a diet of jalapeno poppers & curly fries, dipped in ranch dressing.  That is all I would eat: morning, noon, and night.  Why?  Because IT TASTES GOOD.

Remember, a treat is a treat, not a meal.  Remember food is fuel for your body, and treat your body right.  (See my brief earlier post: fuel for your body. )

Would I like to live on curly fries?  Would I like for every single thing I put in my mouth to taste as good a hot, freshly fried and breaded jalapeno popper, filled with dripping melted cheese, and dipped in thick creamy ranch dressing?  Yes I would.  But if I did that, it would be the same as putting sand in my car’s gas tank.  Food is my fuel.  Once in a while I cheat, but I remember that the primary goal of my eating is to fuel my body, not my tongue.

1)  I have kids (or grandkids) that I chase around.
Nope, sorry that is not exercise unless your 4 year old is running around a track for 2 miles.

2)  I’ve got a lot of acres on my property and I clean brush and tree limbs.
Not going to cut it, that’s not exercise.  Before you tell me I’m a city slicker that doesn’t understand manual labor, as a high school student and college student in Los Angeles I had summer jobs with contractors and landscapers and worked in 110 degree heat digging, building, cutting, sawing, and everything else in between.

3)  My workplace is in a large plant and I do a lot of walking.
Unless you are walking for about 30 minutes straight at 3 miles per hour, that doesn’t cut it.

4)  I do [fill in the blank]  and I know it is good exercise because I sweat a lot.
Sweat doesn’t mean it is good exercise.  Get a heart rate monitor instead.  A high heart rate indicates adequate exertion.

5)  I mow my lawn on a riding mower and it is very bouncy.
Are you freaking serious?  Bouncing is not exercise.

6)  I clean my house.
Once again, not exercise.  If you think it is such great exercise, I will give you my address and you can clean up after my 7 and 5 year old daughters.

7)  I walk with friend.
If you walk with your friends and catch up on the latest gossip, you aren’t walking fast enough.  Remember, exercise is supposed to be hard.  If you can easily carry on a conversation during your activity, it probably isn’t adequate exercise.

In order to reach your weight loss goal with the Lap Band, you need to exercise.  Enough said for now.

People are often surprised to see that they can actually lose weight by having fluid taken out of the Lap Band. This will be the case if they are in the “red zone.”

See earlier posts on fills such as
Lap Band Loosening
Lap Band fills
Lapband Sweet Spot

But they were discouraged and unsure of themselves because they said that a friend told them they need to lose about 40 pounds a month!

What a bunch of crap!  It is physically impossible to lose 10 pounds a week unless we stared cutting off your limbs or something like that.

This brings up an important point.  Along your weight loss journey you will run into a lot of people who are destructive to your success.  They will try to demoralize you.  They will try to mock you.  I don’t know why they do it.

Perhaps they are jealous that you have found a solution that they don’t have for your weight and your health.  Perhaps they are embarrassed at their own situation.  Perhaps they don’t want to see you empowered.  Perhaps they are envious that you have shown the courage to take control of your health and they have not.

Whatever the case may be, you will unfortunately run into people that are destructive to you and your journey for weight loss.   Ignore them.  They are the losers.  You are the winner.