Lost

Well the other day I thought I would call Dr. Simpsons office to confirm my appointment for the 7th. I was told that since I have Medicare Aetna that they could not do my surgery since they do not use a Center of Excellence.  I said if I was pure medicare that is true.  So I called Aetna and they told me I could use them.  Should I go to my appointment and just tell them they are not correct and they need to call or should I just goto someone else?

Ray, Before you cancel; you might want to speak with Darcie at the office.  She knows insurances inside and out.  I know from past experience that Aetna or whoever is the secondary insurance wil follow the guidelines of Medicare and Medicare absolutely dictates a Center of Excellence.   Insurances often give info that unfortunately does not pan out when the pre-authorization requirements are challenged! You may want to find a surgeon who has actually done someone with your exact insurance combination.  That way you know you will not be dropped after jumping through many hoops and waiting a long time.  Bridges St Luke's works with Medicare and Aetna and is a Center of Excellence.  Good luck!

When I talked to Medicare they say before I pay extra for the Aetna plan then you need to follow Aetna's rules.  You got to love the run around.  I even asked them about Aetna no having any surgeron and hospital combo that falls into both working.  They said use Aetna's guidelines.

Ray - Judy knows what she talkin about, for sure follow her advise.  I am a Doc SImoson Bander and their office is GREAT, but if your insurance will cover it somewhere else, I'm sure Judy knows another DOc of excellence!!!  Good Luck with everything and I read your story, funny about the show "Intervention" because we contacted them about my neice and they seemed very eager to help us as well and then left us high and dry after us waiting about 2 mths and my neice getting further into trouble, I am glad you are doing this YOURSELF because you will feel better about your results knowing you took the steps.  I am 5mths out from Banding and have lost -63Lbs anfd all I can say is my depression is a THING OF THE PAST, mentally I am so much more stable now then I've been in years.  Good Luck and Keep Us Informed, DOc SImpson has a support group at his office on Tues 8/14 if your app't goes thru be sure to attend this with your wife, you'll meet so many WONDERFULL people!  Take care & God Bless

Thank you both for the advice.  I think I am just going to go to my appointment anyways.  I guess then I can have the verify it all and go from there. As for the show, I could not believe that they would have started filming us and just leave.  I would have thought that they would have offered some help.  Before all that I loved watching the show.  I thought they really cared and help people.  Now I can not even think abou****ching because I know the truth about it.  The one good thing that happened is that I know how my family "really" feels and how worried they are.  In a way it was my slap in the face and for that I am thankful. As for my depression it's a battle all the time and dealing with the problems getting this approved really wear me down.  Sometimes I really feel like giving up but I know deep inside I can not.  I know I owe it to my little girl and myself.