jupitersmile71

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I haven't posted anything for a while. I am still moving forward w/ losing weight on my on. I've managed to lose 70 pounds since April 2008. I no longer want to have bypass surgery but I am on the fence about having lap band. Ideally, I don't want surgery. I rather use the extra cash for cosmetic surgery. 

I've managed to lose the weight by following a low gi diet and walking every day (min 6 x a week) and lifting hand weights.

I was notified by my insurance company that Dr. Ganta was a participating provider in the Austin area. I read some of his reviews and read some information about him on the internet. I have a consultation scheduled soon and a seminar to follow. 

I had looked into using Dr. John Pilcher or Dr. Nilesh Patel in San Antonio they are both out-of-network. One doctor says he will only charge me in-network benefits but couldn't put it in writing. I would feel better knowing that my surgeon's office and hospital are only minutes away from my house instead of 100 miles away. Besides, I don't want pay out-of-network benefits - usually double the cost of in-network benefits.

I met w/ my PCP today. The visit went well. She is on board and has given me her "blessing" for surgery. She has agreed to supervise my required 6 month diet for BC/BS TX. She has made it tough but I am going to give it a try. Before I headed out to my appt today I found out that Dr. Pilcher is not participating w/ my insurance. I was confused. I clearly saw his name on the list. It turns out he has affiliation with two practices and no longer uses the provider number I looked up. How was I supposed to know? No one in their office told me he had two affiliations. So now, I am stuck w/ the bill for the consultation and if I decide to stay w/ him as my surgeon he is asking for $4K (pre-op). That's a bit much when all I would have to pay is $1750 if I find a network doctor. One thing I learned today from my insurance carrier - there is something called an "Exception Pre-authorization". A non-network physician can get paid as of they were in-network if there is no doctor that can do that type of service w/ in a 75-mile radius. If I would have known this, I would have gotten a pre-authorization before my consultation on 3/26/08. There is not much I can do at this point but pay $4K (my surgery portion) or look for another doctor. I am looking into Dr. Nilesh Patel. If you are reading this and you have seen him please contact me. I'd like to know more about him. I understand he has an office in Austin - that would be great!!!!