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

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

TIP 4:  always take the stairs.  Although you will not lose 100lbs doing it, every extra calorie you burn helps get you toward your goal a little quicker.  I have seen estimates that just by taking the stairs instead of an elevator, you can lose 11 extra pounds per year! Consider that free weight loss without having to suffer calorie loss

TIP 3: watch out for “naturally” sweetened products or “organic” products. Just because the sweetening isn’t sugar doesn’t mean it doesn’t have lots of calories! “Natural” brown sugar and honey have as many calories as sugar. “organic” just means it was grown without chemicals, not that it is low-calorie or even particularly healthy for you in other ways.

TIP 2: When you go out to eat in a restaurant, ask for a “to go” box when you order your meal. Yes, this may seem a little odd at first, but if you carve out the portion you’re supposed to eat and put the rest away in a box at the very beginning, you’ll be less likely to overeat at your meal. Plus, it will mentally prepare you/remind you to eat only what you’re supposed to and not everything that’s put before you.

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A recent comment on one of the posts suggested we start a “Tip of the Day” section which I think is a great idea.  I’m not sure if I can actually manage to come up with a new quickie idea every day, but I’ll try to post a tip at least 4 times per week.

So with no further ado, my first quick tip: Find something to mentally distract you while you work-out. If you can hear yourself panting, huffing and puffing it will make you feel more fatigued than you really are and make you quit a lot earlier than your body really needs you to.  Playing music on headphones serves this purpose well, but studies have also shown that if you play music with a moderate to fast beat, you’ll actually walk/jog/gazelle at a faster pace and therefore burn more calories.  TV also works well as does exercising with a friend or in a super pretty place (like a beach).