Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 Hi All. I am fairly new to this group so bear with me if I have questions a million people have asked. I found this group through the DS Insurance Auth Problems group. More than anything you have all confirmed my beliefs that I am going to do whatever possible to get the DS. Hull advised me to make an appointment with Dr. Anthone in CA, which I am, but in the meantime I am trying to find someone who will do the same type of thing here that Dr. Anthone does with the insurance coding. So, I made an appointment with Dr. Macura in NY. I believe there are several of you on this list who have been to him. I am just looking for any advice about the first consult. I had an appointment in NJ with a Dr. for RNY in August and I should have been having my surgery any day now. Someone was watching over me because the hospital is no longer allowing the surgery (long story). I have finally come out of my depression over that and as I said before feel like I almost made the biggest mistake of my life. For me I know the DS is the right surgery. I am 5'2 and weigh 280lbs, BMI 49. I've heard the whole BMI over 50 is right for DS, well I am going for it. I just would like to know if there is more I should be asking Dr. Macura, I know he does both RNY and DS, and if he pushed anyone to towards having RNY over DS. This is what happened at Mt. Sinai with me, that's the reason I am no longer going there. Just looking for any advice and some prayers that all will go smoothly on Monday and I will be on my way. Thanks! Tami P.S. I am 30 and very definitely want to get pregnant in 2 years or so. My ob/gyn said there should be no problem as long as I am careful with the malabsorption and make sure I keep in close contact with him. I feel even better about that after reading the abstracts posted. Thanks again Chris! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 Thanks Rita. I have a friend who had RNY with Dr. Macura. She recommended him but wasn't sure he would do the DS on me because of my BMI. She absolutely loves him also, I hope I feel the same way and both of you do after Monday. I just hope he will work with my insurance the way Dr. Anthone does, otherwise I will be heading for California (not that it's a bad thing, just my family would be much happier if I was here). Do you know of anyone who has had insurance problems and went to Dr. Macura? Guess it would make me feel better to know he will work with the insurance problems, since the Dr.'s at Mt. Sinai just completely dismissed me when I told them I absolutely didn't want the RNY. Wish me luck Monday... Tami Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 Lisbeth, Thanks for your encouragement! I feel much better about him going along with me having the DS now. I've been through so much with this I think I would go nuts if a doctor tried to push me to the RNY at this point. I had also heard that his practice was getting very busy. Lucky me, I faxed them back my application on Friday night. Monday morning at 8:45 they called and set up an appointment next Monday. I was shocked. I truly don't care if I have to wait (remind me I said that when I get impatient) I just know I want this surgery. Let's just hope the rest of this process goes as easily as setting up an appointment! I just feel so much better after having read about all of you. I know I am doing the right thing. I'll let you all know how it goes. Tami Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 > " the Dr.'s at > Mt. Sinai just completely dismissed me when I told them I absolutely > didn't > want the RNY. " > , Sorry I should clarify that for everyone on the group. I have Aetna and when my original surgery got cancelled I started to look around for other doctors who accepted Aetna. I found the group at Mt. Sinai and the DS. I sent them an email, and received several emails back from both Dr. Pomp and Dr. Herron ( which I sent pieces of to the DS Insurance Auth Problems group, I will send you copies if you want them). They both said there is no way my insurance will cover the DS and regardless I should have the RNY because my BMI is under 50. Well, they are excellent doctors and I trust their judgement but I know they do DS on people with BMIs under 50! I'm sure they just said that because of my insurance. And I am not going to give up on my hope of having the DS just because of my lousy insurance! Thanks to Hull I now know I have an alternative. So don't worry about going to the Mt. Sinai doctors. I am positive it was just a personal experience. I didn't mean to cause anyone concern. Guess I'm ticked at insurance and taking it out a little on the doctors too.... Tami Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 Lisbeth, I'm in NJ. About 1/2 hour out of Manhattan. I have a PPO so I can go out of state to any participating doctor and pay the in network fee. Dr. Macura takes Aetna, but Aetna (to my knowledge) will not cover the DS. Hopefully he will write it up the way Dr. Anthone does and I will just have to pay for part of the surgery. I am prepared for Monday with all of my information on this from Hull (thanks Chris). I just feel so relieved about this whole thing now that I have found the DS and this group. I know it was meant to be. Thanks again for the kind words. Tami Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 Tami, I had surgery with Dr. Macura, when I went for my initial consult he asked me if I knew that he performed two surgeries and I said yup and went on to describe both the DS and the RNY (he sat there patiently probably thinking wow she can talk) at the end he said...I wish all my patients knew as much about either surgery he then asked me which surgery I was interested in. I said DS he said great. He said he was seeing some fabulous with results with the DS even with lower BMI patients such as myself. My BMI was 42 at the time of surgery. I can honestly say I love his Dr. Macura he is a really nice guy and he has tons of patience. Lately though there are lot more people who have heard of him so as a result you may be waiting a bit longer in the waiting room. My insurance approval only took days so I can attest that the staff is efficient. If you have any questions call Gertrude she is his program manager she had the RNY years ago she looks great! Several other doctors joined Dr. Macura's practice Dr. McMullen and Dr. Nicastro. Dr. McMullen is very nice. Dr. Nicastro is very attractive (and not so nice, just a personal opinion). I have called them to ask questions and they have been great about getting back to me. I have only positive things to say about Dr. Macura to be honest and would recommend him highly! Good luck and please keep us posted! Lisbeth tks498@... wrote: Hi All. I am fairly new to this group so bear with me if I have questions a million people have asked. I found this group through the DS Insurance Auth Problems group. More than anything you have all confirmed my beliefs that I am going to do whatever possible to get the DS. Hull advised me to make an appointment with Dr. Anthone in CA, which I am, but in the meantime I am trying to find someone who will do the same type of thing here that Dr. Anthone does with the insurance coding. So, I made an appointment with Dr. Macura in NY. I believe there are several of you on this list who have been to him. I am just looking for any advice about the first consult. I had an appointment in NJ with a Dr. for RNY in August and I should have been having my surgery any day now. Someone was watching over me because the hospital is no longer allowing the surgery (long story). I have finally come out of my depression over that and as I said before feel like I almost made the biggest mistake of my life. For me I know the DS is the right surgery. I am 5'2 and weigh 280lbs, BMI 49. I've heard the whole BMI over 50 is right for DS, well I am going for it. I just would like to know if there is more I should be asking Dr. Macura, I know he does both RNY and DS, and if he pushed anyone to towards having RNY over DS. This is what happened at Mt. Sinai with me, that's the reason I am no longer going there. Just looking for any advice and some prayers that all will go smoothly on Monday and I will be on my way. Thanks! Tami P.S. I am 30 and very definitely want to get pregnant in 2 years or so. My ob/gyn said there should be no problem as long as I am careful with the malabsorption and make sure I keep in close contact with him. I feel even better about that after reading the abstracts posted. Thanks again Chris! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 " the Dr.'s at Mt. Sinai just completely dismissed me when I told them I absolutely didn't want the RNY. " Oh no.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 Thanks for the clarification Tami. I have a BMI over 50 and I have United Health Care. The Mount Sinai insurance people have told me that United routinely approves this surgery with their doctors. My initial consult is this Thursday. I've had as much pre-op testing done as I could: colonoscopy/endoscopy, chest x-ray, stress/echo, psychiatric. All consider me fine for surgery, I am relieved to say. I'll let everyone know what happens. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 Tami, I know how you feel! When I was researching surgeons and all I kept hearing was RNY I wanted to physically remove the those letters from the alphabet so when I learned about Dr. Macura and the process was painless, I felt like it was a sign that yes I was going to have surgery and yes it was going to work out...Its funny because whenever I go I catch them right before the rush but let me tell you that the office is filling up fast!!!! Which I think is a good thing. Btw Tami where are you from? I live in NYC uptown manhattan to be exact. *hugs* Lisbeth tks498@... wrote: Lisbeth, Thanks for your encouragement! I feel much better about him going along with me having the DS now. I've been through so much with this I think I would go nuts if a doctor tried to push me to the RNY at this point. I had also heard that his practice was getting very busy. Lucky me, I faxed them back my application on Friday night. Monday morning at 8:45 they called and set up an appointment next Monday. I was shocked. I truly don't care if I have to wait (remind me I said that when I get impatient) I just know I want this surgery. Let's just hope the rest of this process goes as easily as setting up an appointment! I just feel so much better after having read about all of you. I know I am doing the right thing. I'll let you all know how it goes. Tami Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 BTW, I am not positive but I am almost sure they take Aetna b/c when of the patience ahead of me was discussing her insurance with the the secretary....But dont quote me on this! Lisbeth tks498@... wrote: Lisbeth, Thanks for your encouragement! I feel much better about him going along with me having the DS now. I've been through so much with this I think I would go nuts if a doctor tried to push me to the RNY at this point. I had also heard that his practice was getting very busy. Lucky me, I faxed them back my application on Friday night. Monday morning at 8:45 they called and set up an appointment next Monday. I was shocked. I truly don't care if I have to wait (remind me I said that when I get impatient) I just know I want this surgery. Let's just hope the rest of this process goes as easily as setting up an appointment! I just feel so much better after having read about all of you. I know I am doing the right thing. I'll let you all know how it goes. Tami Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2001 Report Share Posted October 23, 2001 Tami, I will keep you in my thoughts and prayers and I will have faith for the both of us! *hugs* Lisbeth tks498@... wrote: Lisbeth, I'm in NJ. About 1/2 hour out of Manhattan. I have a PPO so I can go out of state to any participating doctor and pay the in network fee. Dr. Macura takes Aetna, but Aetna (to my knowledge) will not cover the DS. Hopefully he will write it up the way Dr. Anthone does and I will just have to pay for part of the surgery. I am prepared for Monday with all of my information on this from Hull (thanks Chris). I just feel so relieved about this whole thing now that I have found the DS and this group. I know it was meant to be. Thanks again for the kind words. Tami Quote Link to comment Share on other sites More sharing options...
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