Anyone got insurance to change from one procedure to another?

[Guest guest]

My insurance, CommunityCare HMO in Oklahoma, has approved me for open

RNY with Dr. Gorospe in Tulsa June 22. In the meantime, I have come

across the MGB procedure and read LOTS of your very informative posts

and think this may be a better procedure for me. (For one thing, I

have a 20-month-old son and the shorter recovery time will be

invaluable in caring for him!)

Has anyone else gotten their insurance to make a change like this? I

am not sure how to go about approchaing them...to contact them

directly, to go to my PCP, to start the process with Dr. Rutledge and

let his office handle it...in my HMO, everything has to be a pre-

approved referral from my PCP, so at some point he needs to be

involved, just not sure where...any ideas?

THANKS!

[Guest guest]

> My insurance, CommunityCare HMO in Oklahoma, has approved me for

open

> RNY with Dr. Gorospe in Tulsa June 22. In the meantime, I have come

> across the MGB procedure and read LOTS of your very informative

posts

> and think this may be a better procedure for me. (For one thing, I

> have a 20-month-old son and the shorter recovery time will be

> invaluable in caring for him!)

> Has anyone else gotten their insurance to make a change like this?

I

> am not sure how to go about approchaing them...to contact them

> directly, to go to my PCP, to start the process with Dr. Rutledge

and

> let his office handle it...in my HMO, everything has to be a pre-

> approved referral from my PCP, so at some point he needs to be

> involved, just not sure where...any ideas?

> THANKS!

Yes, I did this. My insurance had approved me for the Fobi procedure

(similar to an open RNY). Basically, that means they were satisfied

that bypass surgery was " medically necessary. " They didn't seem

to be all that concerned about the particular procedure, and

particularly when Dr. Rutledge's procedure should end up costing them

less (less surgery time, less in-hospital time, faster recovery for

you, less risk of complications).

When Dr. Rutledge submitted his normal insurance letter, there was no

problem or delay. You should get the referral from your PCP

immediately, though, if you don't want to be stuck with paying " out

of

network " (about 30% of the cost) yourself.

[Guest guest]

> My insurance, CommunityCare HMO in Oklahoma, has approved me for

open

> RNY with Dr. Gorospe in Tulsa June 22. In the meantime, I have come

> across the MGB procedure and read LOTS of your very informative

posts

> and think this may be a better procedure for me. (For one thing, I

> have a 20-month-old son and the shorter recovery time will be

> invaluable in caring for him!)

> Has anyone else gotten their insurance to make a change like this?

I

> am not sure how to go about approchaing them...to contact them

> directly, to go to my PCP, to start the process with Dr. Rutledge

and

> let his office handle it...in my HMO, everything has to be a pre-

> approved referral from my PCP, so at some point he needs to be

> involved, just not sure where...any ideas?

> THANKS!

Yes, I did this. My insurance had approved me for the Fobi procedure

(similar to an open RNY). Basically, that means they were satisfied

that bypass surgery was " medically necessary. " They didn't seem

to be all that concerned about the particular procedure, and

particularly when Dr. Rutledge's procedure should end up costing them

less (less surgery time, less in-hospital time, faster recovery for

you, less risk of complications).

When Dr. Rutledge submitted his normal insurance letter, there was no

problem or delay. You should get the referral from your PCP

immediately, though, if you don't want to be stuck with paying " out

of

network " (about 30% of the cost) yourself.