Gobo/So much helpful insurance stuff!

[Guest guest]

Hi Gobo,

Thank you again for all your great ideas!

>>>How is your PCP on all this? It wouldn't hurt to get a similarly

worded letter from your PCP. The importants points are to get as much

medical agreement as possible the the DS is the indicated procedure

for you; second to that would be that neither PCP nor approved

surgeon are aware of another plan surgeon who does the DS.

This is my next best hope aside from waiting until switching

insurances next year. Unfortunately my PCP is not all that crazy

about the idea. Apparently he (somewhat reluctantly) referred a

patient of his for the RNY and she had complications that were

keeping her in the hospital for several weeks as of the time of my

conversation with him.

Of course he didn't know any of the details as to what went wrong in

her case or even any of the specifics about wls in general. I will

be VERY interested to see if he is still so against it. I provided

him with a ton of information at my visit in February, and he has had

more than enough time to bring himself up to speed on the subject.

If he has not bothered to do any research on the topic in the last 3

months and still says he is very against it I will not respect

anything he says on the topic. Not as long as I feel I know more

about it than he does.

>

> Actually, it might suffice to just get the surgeon's statement that

> he does not do the DS. If your HMO reps have half a brain, they

> already KNOW how many surgeons there are. Believe me, if they

> try to tell you they can't give out surgeon names again, ask for

> their name, write it down, as well as the date and the time. Then,

> ask to speak to their supervisor immediately. When you ask for a

> rep's name and then follow it by asking for their supervisor's

> name, they generally know they have messed up.

I hadn't asked them to provide me with a list of all their surgeons;

I already have it and I also know it is on their website. I only

asked them to tell me which *specific* surgeon on their list would do

this procedure for me. I can understand them not being able to

recommend a specific doctor for a specific case. That is what PCPs

are supposed to be for because they are supposed to know the

patient's history, etc.

> Ask him to please send the letter to you personally so that you

> may attach it to your appeal. This is important so that you get a

> chance to read what he wrote before sending it in.

I agree. I set up a fax number through eFax, like someone posted a

few weeks ago, for all my stuff to be faxed to me. Then I compile

everything and send it to whomever. That way I know things have been

received and can follow up, etc.

>

> I hope something I've said is useful.

VERY MUCH SO! Thank you so so so so much!

Terri Hassiak

BMI 60

5/9/01 surgery date CANCELLED due to insurance denial

http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398

email(no spaces): bunsofluff @ hotmail.com