Changes

[Guest guest]

Dr. R.

I am not a patient of yours, but of Dr. Shikora in Boston, MA. You

were my first choice, but my insurance put the kibosh on that. Out of

network!

I know when I decided to have this surgery that I didn't want Dr. Shikora

BECAUSE of the long wait. I, like so many others, wanted it done yesterday.

His surgery is also a bit different from yours. But due to my size (over

400lbs) my PCP felt he was the best surgeon for me since he's so experienced

with 'larger' patients.

My point being: impatient people will seek out another doctor!!! His

'weeding out' process takes about 7 months before a patient has surgery. And

when calling to make the initial appointment, a potential patient has to wait

2 months or more. That is a total wait of 9 months or more. Combine that

with possible insurance problems; ie: appeal process (if denied etc) and its

an even longer wait. My total wait was 1 year and 1 week!!

I won't detail his process here but will give you his website. Maybe doing

something similiar to his 'weeding out' process might be something you'd want

to incorporate into your scheduling. If it wasn't for my PCP's insistence

for my safety at my size, to have a surgeon who's operated on many patients

over 400 lbs, I would've gone to someone else and had it done in a much

shorter period of time.

I know by being on this list that I've been green with envy watching people

wiz by me to have their surgeries while I'm still waiting for mine. And

waiting...

Hope this might help you some.

Dr. Shikora:

<A HREF= " http://www.obesityconsult.com/ " >Obesity Consult Center, Boston, MA</A

> or

http://www.obesityconsult.com/

Hugs and Blessings,

Pre-Op

Re-Birthday >August 14th

Dr Shikora

Boston, MA

[Guest guest]

<snip>

>Insurance responsibilities/hassles etc. should be passed on to us. Like

>Diane, I am very fearful that it is SO much easier for insurance companies to

>deny you after the fact.

VERY true.....my insurance company requires prior approval for any

procedure....so even if WLS WAS an included benefit, to have surgery first

and then ask them to pay it, they would refuse because I didn't follow the

proper procedure. Only in an emergency is that allowed---and even though we

may think so, I don't think they would consider WLS an emergency procedure.<g>

>

>I think we are willing to take on more responsibilities relative to insurance

>issues - give us a chance rather than writing us off.

I agree with this.....I participated perhaps a bit more in my insurance

approval/fight. I took my appeal letter from Dr R's office when I came to

clinic. I was responsible for finding the right parties and fax numbers and

I sent the info in by fax and registered mail myself. It was not that

difficult. It only took days to get the denial. LOL But with my HR

departments hard work and mine, hopefully we'll have the right decision by

the end of next month.

>

>I feel like some one has kicked me in the stomach - Please, please listen to

>our concerns. We know you are overburdened and are more than willing to pay

>an application fee or whatever you would ask to make this easier for you.

I think the insurance burden needs to be backed off for Dr R. Put more of

the running around to the patient. As far as the volume of patients is

concerned, many PCP's who are overwhelmed stop taking new patients for a

time, why not Dr R? I think alot of the insurance approval process could be

handled by the patient's PCP. They are more suited to knowing the patients

co-morbidities and would be able to contact the company on the patient's

behalf and know if they even qualify or if their insurance company will even

cover WLS. That would take care of alot of the first time denials.

And yes, many insurance companies only ask for specific items to clear the

first denial...that could also be taken care of by the PCP. But for those

of us with policies that specifically exclude WLS, we have to take it upon

ourselves to convince/educate the insurance company or employer that what

they are doing is wrong. I personally feel that the info that Dr R provided

in my letter was helpful, and I also did research and included materials

that I had also found on the net. I believe that this helped them to take

me seriously. But I could have pulled this info off of the website and sent

it myself, saving Dr R lots of bother to copy and send the information to me.

My employer (who is pretty local to Durham) is now considering the

possibilty of adding WLS (such as Dr R's) as a benefit available to the

corporation as a whole.......which includes 5300 employees (not all of them

morbidly obese, but probably at least 25% of them are). That is why they

are not taking their decision lightly. Either way, I want to have this

surgery, even though having it without the benefit of insurance coverage in

case of complications scares me a little. I wouldn't even want to have any

medical procedure without the " insurance " in case of problems.

This surgery is a blessing for all of us. The more responsibility we can

take off Dr R and his staff's shoulders the better. Let them concentrate on

those patients who are approved for surgery and have packets to approve and

need and have a date set for surgery.

fg

[Guest guest]

<snip>

>Insurance responsibilities/hassles etc. should be passed on to us. Like

>Diane, I am very fearful that it is SO much easier for insurance companies to

>deny you after the fact.

VERY true.....my insurance company requires prior approval for any

procedure....so even if WLS WAS an included benefit, to have surgery first

and then ask them to pay it, they would refuse because I didn't follow the

proper procedure. Only in an emergency is that allowed---and even though we

may think so, I don't think they would consider WLS an emergency procedure.<g>

>

>I think we are willing to take on more responsibilities relative to insurance

>issues - give us a chance rather than writing us off.

I agree with this.....I participated perhaps a bit more in my insurance

approval/fight. I took my appeal letter from Dr R's office when I came to

clinic. I was responsible for finding the right parties and fax numbers and

I sent the info in by fax and registered mail myself. It was not that

difficult. It only took days to get the denial. LOL But with my HR

departments hard work and mine, hopefully we'll have the right decision by

the end of next month.

>

>I feel like some one has kicked me in the stomach - Please, please listen to

>our concerns. We know you are overburdened and are more than willing to pay

>an application fee or whatever you would ask to make this easier for you.

I think the insurance burden needs to be backed off for Dr R. Put more of

the running around to the patient. As far as the volume of patients is

concerned, many PCP's who are overwhelmed stop taking new patients for a

time, why not Dr R? I think alot of the insurance approval process could be

handled by the patient's PCP. They are more suited to knowing the patients

co-morbidities and would be able to contact the company on the patient's

behalf and know if they even qualify or if their insurance company will even

cover WLS. That would take care of alot of the first time denials.

And yes, many insurance companies only ask for specific items to clear the

first denial...that could also be taken care of by the PCP. But for those

of us with policies that specifically exclude WLS, we have to take it upon

ourselves to convince/educate the insurance company or employer that what

they are doing is wrong. I personally feel that the info that Dr R provided

in my letter was helpful, and I also did research and included materials

that I had also found on the net. I believe that this helped them to take

me seriously. But I could have pulled this info off of the website and sent

it myself, saving Dr R lots of bother to copy and send the information to me.

My employer (who is pretty local to Durham) is now considering the

possibilty of adding WLS (such as Dr R's) as a benefit available to the

corporation as a whole.......which includes 5300 employees (not all of them

morbidly obese, but probably at least 25% of them are). That is why they

are not taking their decision lightly. Either way, I want to have this

surgery, even though having it without the benefit of insurance coverage in

case of complications scares me a little. I wouldn't even want to have any

medical procedure without the " insurance " in case of problems.

This surgery is a blessing for all of us. The more responsibility we can

take off Dr R and his staff's shoulders the better. Let them concentrate on

those patients who are approved for surgery and have packets to approve and

need and have a date set for surgery.

fg