Nervous? Excited? Leary???

[Guest guest]

Hey everyone! Congrats to everyone who has gotten approved lately!!!

Best of luck to you Teri, and the rest of you!! Congrats to those of

you who have had the surgery recently, and have had your check ups,or

are now home post op... Best of luck to you for continued success,

and speedy recoveries!

I probably don't post as much as I should on here, but it's just hard

for me to make the time to get online... so I spend one whole day

practically reading all the post! LOL

Well, here is where I'm at on my journey!

Couldn't stand it any longer ( I know.. one more day! HA! HA!), so I

called Pacific Surgery myself. Well, apparently they're REALLY

backed up, and I was given the wrong amount of time to wait (10

business days!)... apparently it's up to 6 weeks, to even find out if

you can get a consultation date! UGH! So, I decided to call the ins.

company myself.. (really impatient aren't I?? LOL) Here's what I

found out...

1) It's not a standard covered procedure.. BUT... it is listed under

Evidence Based Needs and that I must meet the following criteria:

A) General Criteria for WLS (BMI, Diet HX, Medically supervised

program, WT, DX, have tried WL medications, and any co-morbids)

Now this I have a question about! My PCP.. will NOT prescripe WL

medications... he says that the WL clinic handles all of that...

well, he gave me a referral, but it was going to be WAY too

expensive.. like $200/mo!! OUCH! AND they said they DO NOT prescribe

medications... only liquid diets (in extreme cases). And I am

seeing my DR. and nutrionist at the same time.. is this a medically

supervised WL plan??? (am crossing my fingers!) I REALLY can't afford

the WL clinic! Ok, next! LOL

Get referral from PCP, and him approve the Dr/Surgery.

C) MUST BE APPROVED BY MEDICAL GROUP!! (RED FLAG!!) Really

scared about this one!! My friend just had the RNY, and she has the

same Medical Group as I do, and she said that there is NO WAY they're

going to approve me to see another doctor or have any other surgeries

other than the RNY, that I should just call and make an appt with Dr.

Callery for the RNY.

But these are TWO different surgeries!!! Do you HAVE to settle for

just ONE surgery????????? This seems totally unfair when it's THE

REST OF OUR LIVES!! Am just wondering has anyone else had any

experience like this? Or anyone have any advice??

I'm kinda excited... WAY nervous... and REALLY leary about the

medical group approval!

My nutritionist even said that I needed to do something. I'm only

eating like 9-1200 cal/day, and yet I'm still GAINING! She said it's

not making any sense! So, I called and moved my appt up with my PCP

from July 2nd, to June 13th... so I guess I just start there?????

Any advice before then would be greatly appreciated! Am already

gathering info in MY favor!!

Thanks all.. and sorry for the long post!

If you want to e-mail me privately, please feel free to do so! Thank

you!

~

BMI 43.7

WT 243

Just beginning my journey!!

[Guest guest]

Hi,

I am 4 weeks post op and have lost 35 lbs. I can not have the RNY

because I had a gastric band that created a small opening and I kept

forming scar tissue that closed the opening. The RNY makes a small

opening and the scar tissue is a common problem with it.

I wrote my own letter of medical necessity and faxed it to my PCP

citing all my co-morbidities. He signed it and sent it off and I was

approved in 2 days after the insurance company received it. I was

approved for everything before I ever saw Dr. Rabkin so it made it a

little easier. I didn't have to wait for his office to file the

letter. If your doctor thinks that this procedure is the best

procedure for you I don't think that your insurance company can make

you have the other. They may make you pay out of network costs but I

had to do that since I am from Texas.

Good luck and don't give up!

Ellen

> Hey everyone! Congrats to everyone who has gotten approved

lately!!!

> Best of luck to you Teri, and the rest of you!! Congrats to those

of

> you who have had the surgery recently, and have had your check

ups,or

> are now home post op... Best of luck to you for continued success,

> and speedy recoveries!

>

> I probably don't post as much as I should on here, but it's just

hard

> for me to make the time to get online... so I spend one whole day

> practically reading all the post! LOL

>

> Well, here is where I'm at on my journey!

>

> Couldn't stand it any longer ( I know.. one more day! HA! HA!), so

I

> called Pacific Surgery myself. Well, apparently they're REALLY

> backed up, and I was given the wrong amount of time to wait (10

> business days!)... apparently it's up to 6 weeks, to even find out

if

> you can get a consultation date! UGH! So, I decided to call the

ins.

> company myself.. (really impatient aren't I?? LOL) Here's what I

> found out...

>

> 1) It's not a standard covered procedure.. BUT... it is listed

under

> Evidence Based Needs and that I must meet the following criteria:

> A) General Criteria for WLS (BMI, Diet HX, Medically supervised

> program, WT, DX, have tried WL medications, and any co-morbids)

>

> Now this I have a question about! My PCP.. will NOT prescripe WL

> medications... he says that the WL clinic handles all of that...

> well, he gave me a referral, but it was going to be WAY too

> expensive.. like $200/mo!! OUCH! AND they said they DO NOT

prescribe

> medications... only liquid diets (in extreme cases). And I am

> seeing my DR. and nutrionist at the same time.. is this a medically

> supervised WL plan??? (am crossing my fingers!) I REALLY can't

afford

> the WL clinic! Ok, next! LOL

>

> Get referral from PCP, and him approve the Dr/Surgery.

>

> C) MUST BE APPROVED BY MEDICAL GROUP!! (RED FLAG!!) Really

> scared about this one!! My friend just had the RNY, and she has

the

> same Medical Group as I do, and she said that there is NO WAY

they're

> going to approve me to see another doctor or have any other

surgeries

> other than the RNY, that I should just call and make an appt with

Dr.

> Callery for the RNY.

>

> But these are TWO different surgeries!!! Do you HAVE to settle for

> just ONE surgery????????? This seems totally unfair when it's THE

> REST OF OUR LIVES!! Am just wondering has anyone else had any

> experience like this? Or anyone have any advice??

>

> I'm kinda excited... WAY nervous... and REALLY leary about the

> medical group approval!

>

> My nutritionist even said that I needed to do something. I'm only

> eating like 9-1200 cal/day, and yet I'm still GAINING! She said

it's

> not making any sense! So, I called and moved my appt up with my

PCP

> from July 2nd, to June 13th... so I guess I just start there?????

>

> Any advice before then would be greatly appreciated! Am already

> gathering info in MY favor!!

>

> Thanks all.. and sorry for the long post!

>

> If you want to e-mail me privately, please feel free to do so!

Thank

> you!

>

> ~

> BMI 43.7

> WT 243

> Just beginning my journey!!