Insurance question---How to procede

December 21, 2001

I need anyone and everyone's help with an insurance issue. A cousin of mine

has decided to have the BPD/DS. He is diabetic. He is on numerous meds for

diabetes and still his blood sugar is often out of control.

The trouble is he is in Illinois (as I am). He has an HMO through United

Healtcare. All of the providers in his book are in the Chicago area. Of

course since there are no DS physicians in the Chicago area there is no DS

surgeon in this book. He had a consult with Dr. Hess. If he can get

insurance approval, he can have surgery very soon. Here are my questions:

1. How is United Healthcare (in general) about the BPD/DS? Do they tend to

pull the experimental thing?

2. If they are pretty open (in general) to the BPD/DS, then do I prove to

them they don't have a provider by asking for a list of all bariatric

surgeons on their chicagoland list and then calling each one and asking them

if they do the BPD/DS?

3. Has anyone with a United Healthcare HMO gotten them to let them go out of

area for the BPD/DS even though the RNY was offered on their list?

4. Wood County hospital (the hospital Dr. Hess uses) is listed on the WEb

site as a United Healthcare provider. Dr. Hess is not (he doesn't

participate in any insurance). Are they more likely to let you go out of

area to a participating hosptial?

Any other info on strategy would be greatly appreciated. I just want to know

what the best way to procede is so that I (we I guess) don't screw it up.

Dawn

Dr. Hess, Bowling Green, OH

BPD/DS

4/27/00

267 to 165 5' 4 "

size 22 to size 10

have made size goal

no more high blood pressure, sore feet, or dieting!

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