Dr. Farrell

[Guest guest]

Hi

I have been on this list for about 4 weeks working on my packet and

going through what most pre-ops go through with their insurance

companies. Dr. R. has ask that I share something with you.

I have a POS with Kanawaha Healthcare Solutions Inc. The insurance

letter that Dr. R. provided went over very well with my insurance

company however, there is one surgeon in our net work that provides

wls and my insurance company wanted me to see him first. His name is

Dr. Farrell at UNC.

I called his office to make an appointment and our PCP can't make the

referral to see him. He requires all of his MO patients (morbid

obesity-this is what the office staff calls us)to go throuth the

diabetes clinic (even if you don't have diabetes) first. I called

the clinic, the next avaiable appoint for new patients is Jan. 2001.

So, I called Dr. Farrells office back and told them that I could not

get an appointment for 5 months. I ask them to give me some

information about surgery type, # done, etc.. They only told me " we

think he does lap. RUY " . (Notice the quotation marks). Feeling very

frustrated because I could not get the information I needed to show

my insurance c. that Dr. R. and the MGB was the better deal even if

out of network. I asked them to send me some information. I was

assuming I would get some information about him, the services his

office provides etc.. Nope, what I got was the general handbook put

out by the American Society for Bariatric Surgery in Gainsville, FL.

Now this book is good information if you are just starting your

research on wls. It goes throught the different types of surgery and

possible complications. Nothing about his stats, what surgery he

does, etc.

So here is where I get sneaky and I know none of you would ever do

this. But, I called Dr. Farrells office yesterday and pretended I

was my insurance company looking for information about his wls

procedure. I explained that I had a patient that met criteria for

wls and she wanted to go out of network and I was looking at his

practice because he was in our network. They put me right through to

him. He tells me that his WLS program

is just getting started. He is doing the RUY. I asked him if he

was doing open or lap procedures. His response was " I almost always

begin

with a lap procedure " . When I asked him how many he had done there

was

a

pause so I supplied less than 50 and he said " Yes, less than 50 " . No

worries there, NOT! I couldn't get fees because his office doesn't

keep up with this yet.

Dr. R. wanted me to post just in case someone on this list might want

to go to him.

I spoke with my insurance company after talking with Dr. Farrell and

I will be approved for surgery with Dr. R. YEA!!! They will make a

decision about about paying in network or out of net work rates by

monday.

They tell me that they will call Dr. R. office next week and work out

an agreement for a " reasonable and customary fee " . Look out Debbie,

Kanawah (4 county health network) will be calling you next week. Our

insurance management group has never had a request for wls, hope that

will be to your advantage.

Well I have blabbed enough. I am hoping to have surgery the end of

sept or around the first of Oct if approved by Dr. R.

Robin

, NC

BMI 52