My insurance experience (long)

[Guest guest]

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!