Re: My insurance experience (long)

[Guest guest]

I've heard this kind of thing before from people who have had a hard time

with their insurance, that the surgeon's office made all the difference.

Maybe going through the DS surgeon is a little smoother because DS surgeons

are used to fighting for ins approval, so they're better at knowing what to

send to the ins company and how to work with the ins company? Just a

thought.

I'm glad you've made it through to the " other side. " )

alyssa, hoping to make it to the other side by 2002

My insurance experience (long)

> I honestly think if I had found Dr. Hares first, I wouldn't have had to go

> through all the trouble I did. Their office is just wonderful and I think

> they made all the difference for me. I don't think the other place did

> anything wrong, I just think Dr. Hares office put in the extra effort that

> was needed

[Guest guest]

Congratulations Kathy, its stories like this one that proves to me

everything happens for a reason. Thank you for sharing. Hugs

Angels hover ever near,

DS 4/11/01

Bowel obstruction 4/21/01

Dr Deveney @ OHSU

Starting wt 282

Current wt 222

My insurance experience (long)

> My road to WLS was a long and stressful one. I thought I would post my

> experience here to see if it can help anyone looking for insurance

approval.

>

> I first went for a consult in December 1999. I at 5'1 " and weighed 225.

I

> went to a well known RNY place and was told based on my background there

> should be no problems with surgery. At the time I didn't know much about

WLS

> and I didn't even know about the option of DS. I went through about 2

months

> of gathering medical documentation and finally it was submitted to my

> insurance (SelectCare PPO). At first they denied me due to not being

> medically necessary. After several letters back and forth, I decided to

hire

> a lawyer to help as the insurance wasn't giving any good answers. I hired

> Walter Lindstrom and he was wonderful. The letter they sent to the

insurance

> company was so good that my husband and I laughed over it for days. Of

> course the insurance company wasn't impressed and said I didn't have

enough

> co-morbidities. I had sleep apnea, asthma, high blood pressure, joint

pain.

> One more letter from the lawyer got the final response. The insurance

> company said I didn't have any history of trying to diet with a medical

> doctor. I had tried about every commercial diet under the sun, but they

> wanted something from a physician. Between the WLS place and the lawyer,

it

> was decided that I should work with my regular doctor for 6 months and try

> again. By that time it was the end of 2000 and I had open enrollment for

my

> insurance. It was also suggested by the WLS place that I switch to Blue

> Cross PPO. I did that and started working with my doctor. I took Xenical

> (horrible stuff) and in 6 months I lost 10 lbs. It was June and I was

ready

> to try again for surgery and called the WLS place. I had sent them all my

> insurance information in January of 2001 and had never heard back that

there

> was any problems. When I got them on the phone, they told me that they no

> longer took the type of Blue Cross PPO I had and I should switch insurance

> again and try again in January of 2002. I was devastated and I knew that

> waiting more just wasn't an option. I was getting a little discouraged

with

> the WLS place and I decided to find another surgeon who did take my

> insurance. The first one on the list I called said they no longer did

WLS.

> The second place I called was the best phone call I have ever made. I

called

> Dr. Hares office and spoke to Jackie. She sent me the information and I

read

> through it for about a week before I scheduled a consult. After meeting

with

> Jackie and learning more about DS (which is what Dr. Hares does), I

started

> to do more research about surgeons in my area and the different surgeries

> available. I was so happy when I read all the information about DS and

the

> surgeon. I started to attend support meetings and went for my pre-op exam

on

> July 12. I had a tentative surgery date of August 7th. The office didn't

> feel I would have any problems with insurance. On Friday they called me

to

> say that there was a cancellation in the surgery schedule for the next

> Thursday and if I could get all the pre-op testing done in time and the

> insurance came through, I could have the date. I was a mess for the whole

> weekend and I didn't want to get my hopes up at all. After waiting and

being

> disappointed for so long I expected the worst. On Monday I kept checking

> with the office to see if they heard from the insurance company. At the

end

> of the day, there was still nothing. We had a support meeting that night

and

> when I got there the office manager was so excited and told me the

insurance

> came through just before she left and there were no problems. I didn't

even

> need my diet proof from my regular doctor or anything! I went to work the

> next day and announced that I would be out for 6 weeks. I didn't tell

anyone

> why and I think they all thought I had cancer. I did my bowel prep on

> Wednesday and surgery was Thursday.

>

> I honestly think if I had found Dr. Hares first, I wouldn't have had to go

> through all the trouble I did. Their office is just wonderful and I think

> they made all the difference for me. I don't think the other place did

> anything wrong, I just think Dr. Hares office put in the extra effort that

> was needed. Now that I am on the other side, I am so glad I had DS

instead

> of RNY. I am 6 1/2 weeks post-op and starting to feel like myself again.

>

> I feel very lucky to have found Dr. Hares and the DS surgery. I guess if

> things had gone easier, I may have ended up with RNY and not known about

DS.

>

> Thanks for giving me a place to talk about all of this.

>

> Kathy M.

> DS 7/19/01 Dr. Hares

> 213 pre-op

> 174 today!

>

>

>