my insurance letter & my friend is going to Dr. K

[Guest guest]

Well, I called Med Mutual at 8:45 am (they opened at 8:30 - was I anxious? oh

no! Not me!) and was told that what Dawn said was what they meant with that

letter. The woman (and I did get her name) told me that this was just a

" warning " letter so I would be aware of the fact that they would not pay 100%

for out of network, but will pay the percentage my plan states, which is 70%.

I am hoping that the $2500 I put upfront covers the difference for Dr. Hess.

I called his office again, too and the nurse there told me that this is a

normal letter and as long as Dr. Hess gets $5,000 total with my $2500

(another $2500 from insurance) that that would be enough. If he gets less,

then I will have to pay the difference. I think I am ok on this, as others

who had Med Mutual didn't have to come up with any more money for Dr. Hess.

However, I have gotten word from others who say he also has an assistant and

they had to pay the difference for the assistant. So, I asked about this,

too, and Dr. Hess' nurse told me the assistants are either Dr. Oakley (if he

isn't doing his own surgery that day), Dr. Hess' daughter, Dr. Luana Hess,

or Dr. Albert . I checked Med Mutual and none of those assistants are

in their network.

The good news, though is that Wood County Hospital *is* in network and

insurance said they *would* pay 100% for their charges. The letter only

names Dr. Oakley (since he is the one I originally saw and the one who

submitted the original letter to insurance) as the one they will not pay 100%

to.

So, thank God, this is as I thought it was and I *can* go out of network,

they will pay for *some* charges, just not *all*. Hopefully, my out of

pocket expenses will be manageable by me.

I also called the social services office of my state (OH) just out of

curiosity to see if they have any provision for me if I am not able to work

and not able to collect unemployment while healing from surgery. I haven't

gotten a call back yet, but this was suggested to me by someone, so I thought

I'd just ask anyway.

Also - just wanted to let those know who have kids that if you are not

working and have dependent children, you can get Medicaide or state insurance

usually pretty easily and I think most of them will cover the DS? Something

to look into.

I have a very good friend in California who was the first one to bring up

having wls to me and got me started down this road. Well, I found out about

DS and told her about it and she was *so glad* because when she read about

RNY and Fobi pouch she didn't think she could do it. Well, thanks to all of

you, she is going to go to Dr. K in Delano - I told her about him. And the

good thing is, she has 2 girls under 18 yrs old so she got on Medicaide and

it will pay for the surgery!

Carole