Keys to finding the right surgical provider for Lap-band surgery. Two key elements to consider are the experience and knowledge of your surgeon and the quantity and quality of support after surgery. Price is also important. You should know what is included in a price. Does it include tests? Is your surgery done in a hospital or an out-patient facility? Does it include overnight hospitalization? Does it include adjustments (fills) and office visits? How many and for how long? Are your office visits with the surgeon or some unknown staff member? Do you get lifetime support? Beware of bait and switch tactics were they quote you a low price, but subsequently charge for “extras.”
The experience, reputation, and knowledge of a Lap-band surgeon
There are many surgeons who are qualified to place the Lap-band, but there is a difference in the quality of their work. Many surgeons will tell you how many bands they have done, but there is one place you can go to find out how many they have done. If you go to www.lapband.com and do a physician search in your area you will find surgeons close to you that do the LAP-BAND procedure. They also are able to tell you who has done at least 75 bands over the last six months. Surgery is like many other skills – the more a surgeon does, the more experience they have. As with any task, whether it is changing oil in your car, knitting a sweater, fixing dinner — the more you do something, the better one gets — in general. There are some naturally gifted surgeons who can do any surgery well even if they have only done a few. It is difficult to judge that from a layman’s perspective. So, while more is not always better, the information in lapband.com will show who tend to do more operations than others. This also helps you have some real information — if a surgeon claims to have done more, but it is not backed up by the information available, you might be concerned.
Lapband.com will also tell you if the surgeon is involved in training other surgeons. Allergan, the company that makes the LAP-BAND, is very picky about who they choose to teach others. The Realize band, from Ethicon, requires a surgeon to do 20 of their Lap-bands before they teach others, while Allergan requires hundreds of bands done with outstanding results. The Allergan representatives see all the surgeons operate and is partially based on the number of operations a surgeon does. It is also based on how well the surgeon conducts the operation. The company will not recommend one surgeon over another and all Allergan surgeons have been proctored by another surgeon before being able to do the operations on their own. Thus, all Allergan trained surgeons can place the Lap-band. Still, having a surgeon who trains other surgeons is a marker of a surgeon who has not only a vast experience but who has the ability to teach other surgeons. Be aware, almost every surgeon wants to have that extra seal of training others – and put a lot of pressure on the company to get that “seal.”
Taking care of you after Lap-band bariatric surgery
The LAP-BAND is more than an operation. It is learning how to live with it after surgery. This is more difficult than the operation itself. The operation is critical, but learning how to take care of yourself with the Lap-band is even more so. It is not simply having an operation and getting the Lap-band adjusted — it is a learning program that takes time and commitment by you and your surgeon.
Some surgeons offer their cell phones and their email address to patients. This is a good feature. This means that you can be in contact with your surgeon for any issues. Some issues may seem trivial to the patient but are critical to us. Heartburn, night cough, reflux after the Lap-band — for example, may be trivial but they may also represent a Lap-band slip. You need an evaluation by a surgeon for these issues — those are not issues that should be addressed by a fellow patient over the phone. Having the ability to easily contact the surgeon is important.
Support groups are generally offered by all surgeons. Not every patient thinks support groups are important but a well established support group can be an important adjunct to your care. Here are the keys to an active, vibrant support group that will help you on your way: (a) that the surgeon is present for many of the support groups — this shows that the surgeon cares and provides an opportunity for a patient to ask a question in a non-clinical environment. (b) Structured support groups — having topics that are relevant to the care of a Lap-band ranging from psychological support, nutritional support, exercise support — all provide a structure around which a patient can expect new and varied topics.
Support groups are a part of the support and sometimes charged separately. If the support group costs are for a year or two, consider if you want that and more. If the support groups are not worth attending then it is not an issue — but a worthwhile and vibrant support group means more than meetings – -it may mean things like “Spring Flings,” or other parties for patients. Finding new friends who have something in common (the Lap-band) is a great support system.
Podcasts are a means by which patients can get topics from their surgeon that they can download and listen to or even listen on a computer. This provides another means of support to help with common topics. These can be audio topics that you could download onto a CD and listen to in the car or video support.
A website that is more than just a patient selling tool. Websites come in variations but they can be used as a mechanism for support. From message and forum boards where patients can have questions answered to basic information. This takes dedication by the surgeon and the website to constantly update and provide information to the patient.
Books, workbooks, and extensive patient information materials are another mechanism that surgeons can provide patients with information, insight, and even recipes. These again show that there is more care and information in it.
Personal touch in your Lap-band surgery care and support
Bariatric surgery for some corporations is “big business.” There have been a number of corporations, including out-patient and hospitals, that place a lot of money into advertising for patients. Some of these corporations simply advertise for a surgeon who brings them their business. Some employ surgeons who simply do the operation and have little or nothing to do with the patient after surgery. Beware of these. You want a surgeon who is involved in your care from the operation to taking care of you after surgery. A corporation can set up a “fill center” where you are filled by a technician and they bill insurance. You may not even see a surgeon even though a surgeon may “read” your x-ray. There is more to an adjustment than having saline put in and taken out. Some of the people do a great job of this — and some do not. For example, in Seattle, Northwest Weight Loss has Jessie Ahroni — who has probably done more fills, has more intimate knowledge of what is being done than almost any surgeon. Jessie is a great resource — but rare.
Beware of big Lap-band surgery corporations
Surgical Providers where you become nothing more than a number in the system. Beware of physician brokers. These are independent people who receive a kick back for each patient that they sway to book with a surgeon they represent. If they don’t book any surgeries, they don’t get a paycheck! They may represent one surgeon or several. They may set up separate websites offering to let you choose your surgeon, when in reality, they are choosing for you! These people will do and say anything to get you to use them! These brokers are also people that are on the end of other 800 numbers for big corporations or hospitals.
If you go to a seminar and the surgeon isn’t there – -what is the point? You want to see the surgeon. You want to be able to ask the surgeon questions and determine what level of care they offer you after surgery. Do they do the adjustments or the majority of them?
Beware of up-charges for pre-surgical tests
Some facilities or surgeons will give you a low price by offering a minimal amount of tests in a package. But once you get there they make money by requiring more tests than in the original offer. Tests are not a bad thing but it is important to know if you really need them or if the surgical provider just gives them to everyone to make more money. For example, some surgeons will do endoscopy on all patients — not that this is needed or indicated for the LAP-BAND — but this is another mechanism for up-charging patients. Some centers have sleep labs, stress tests, and other laboratory tests — all of which they will charge your insurance company for or you. Sometimes these tests are needed, and warranted, and sometimes they are a mechanism for more income for the surgeon or the company that is advertising for your business. They may offer you a Lap-band at one price, but when you go there, they add other tests that are not needed just to give you more of an up-charge. See our section about what tests might be needed. If your surgeon is willing to work with your primary care physician, you may find that you will need fewer tests and only those that are “clinically indicated.”
Here is how up-charging typically works. You are quoted a price for Lap-band surgery then they add endoscopy, a sleep study, and a stress test. Sometimes these are needed, or even wanted, sometimes they are not.
The price of Lap-band fills or “adjustments”
Some surgeons include office visits and fills in the price of your surgery. This allows you to know the entire cost for the surgery and aftercare at the outset. Be prepared that you may need six adjustments in the first year, sometimes more — sometimes less. You should calculate how many times you will need these. Not only should you find out who does the adjustment (physician or technician) but exactly what involvement a surgeon has in them. If they charge $300 for a fill — this could mean an additional $2100 to the price of surgery! The rock bottom price offered at the beginning may not be all inclusive.
Some surgeons do fills under “ultrasound.” This is a technique that is often used to bill unnecessary charges to insurance companies. Often the fill port can be felt and palpated without having to use ultrasound. Sometimes it cannot be. Fills do not need to be done under ultrasound or even under an x-ray.
Traveling for your Lap-band surgery
Many will travel to have their operation — sometimes across town, sometimes across the country, sometimes out of the country. The question again is are you willing to travel for the service. Consider, six fills in a year when you think about traveling for the operation. Are you willing to travel to another country to get a fill? Often patients who go out of the country for their surgery find no Lap-band surgeon in your local area will take you on as a patient. Remember, surgeons identify with the patients they operate on. They offer support for their patients. If they care about their patients, they personally participate in providing post-op support and aftercare. Effective Lap-band support programs require a lot of time and energy… lots of time. Because of the time involved, it is rare to find a Lap-band doctor who will take a patient from the outside.
The Lap-band surgical facility – should it be a hospital?
Most bands are done in outpatient facilities. This is safe and reduces the cost a great deal. The question is what is the relationship between the surgical provider and a hospital? If you need to spend a night, where would you do that? This is where sales meets medicine. If they say no one has had to go to a hospital or only one or two — then you have to wonder. Some of our patients have been overweight for years. Their health is not as good as it should be because they are obese. They may have an irregular heartbeat or high blood pressure. It’s much safer for some of these patients to stay overnight, just so we can watch over them. When a surgical provider states that an overnight stay isn’t necessary, that statement is only true for healthy people. Be careful of providers that try to sell you and state that overnight hospitalization is never required — sometimes it is. They might not have easy or economical access to a hospital. Sometimes spending the night is a matter of convenience — if you have children at home and need to spend a peaceful night recovering, that is a reason.
Your insurance company has contracts with some, but not all facilities. There are some companies that will fly you to their facility, put your family and you up in a hotel, provide transportation, and bill all this to your insurance company. The amount they bill your insurance company is a lot more than a contracted rate. Your insurance company is often billed $30,000 to $50,000 for your operation. This can be a disaster when it comes to your insurance. Some patients have found that the insurance company after paying the bill will drop you from its insurance rolls. Further, most insurance companies have a “lifetime limit” when it comes to how much money they will pay for your healthcare. By gouging these insurance companies, they are actually gouging your future insurance dollars.
While it may be enticing to have a “super star surgeon” do your surgery — not having them involved in your aftercare means the surgeon is only doing half the job of your Lap-band.
Sometimes they will then refer you back to the local surgeon who didn’t do your surgery. It would have to make you wonder — if local doctor wasn’t good enough to do your surgery, in the rare event that something goes wrong, do you want that surgeon fixing your Lap-band slip or erosion?
Lap-band surgery extended warranty coverage
No one likes to think about Lap-band slips or erosions. These are all preventable if you don’t abuse your Lap-band. Still, they happen. Paying for an extended warranty for your Lap-band provides a bit of financial security for you and is well worth the price.
Some outpatient centers offer to fix your slip in their facility as a matter of course. This is also an extended benefit that is worth checking into.
The best prevention is to avoid these problems by following some simple guidelines we have outlined in this website.
Choosing your weight loss surgical provider – the bottom line
The lowest price isn’t always the lowest price. Before surgery beware of up-charging for unnecessary and sometimes invasive tests. Find a surgeon that is well regarded for your operation. Know that placing the Lap-band is just half the job — make certain there is the support there for you. From adjustments to support, the Lap-band is something that should not be done on your own. Once you have it figured out you will be fine, but that is typically after a year. Support is the second half of having a Lap-band. If you don’t have the support, your chances of success are much less than if you have a program in place that will help you with your Lap-band.