First step taken.... & Q's

Well, I called UHC this morning to confirm WLS is still a covered benefit for 2006 and that there are no exclusions. I figured it probably wouldnt have changed from last year when Hubby had surgery. It is still a covered benefit for BMI 35+. Now Im going to call Dr Fang, set up an initial appt and the seminar thing. I went to the seminar last year, so now I have to go sit through it again because my name wasn't put on the list last time. Hubby wants me to call and start setting up appts with the cardiologist, pulmonologist and psychiatrist now because he had to wait almost a month for some of his appt's when he did them last year. I still need to find a PCP that will reccomend the surgery for me. Im nervous about that. Does anyone know if you can use your OBGYN instead as the PCP referal??? I hate doctors and avoid them, so I don't have a regular PCP or anyone I have discussed this with. I have PCOS so I am more familiar with my OBGYN and think he would write a referal letter for me. It's all a little overwhelming. Im booking my vacation for Late April or early May--- so that is my plan for surgery. I figure, even if I get my insurance approval and stuff I can tell them that this is when I have my time set to take off (And assuming Dr Fang isnt on vacation or something) they could schedule to match when I want this to happen? Did anyone do that? If I get approved say March, can I tell them what date I want surgery? This is going to be fun.... *sigh* Darlene Hubby: 520/423/200

Hi There I'm a Maricopa person too. Who is requiring that you have a referral from a PCP? Dr Fang or UHC? What plan do you have with UHC I have Choice Plus thru husbands employer and referrals are not required at all. I can choose any physician or specialist I want. Just curious. Good luck to you. I have been lurking and watching your DH sucess, good for him & good for you! Paula Open RNY 4/1/4 330/189/healthy !

Oh let me clarify a little.... I have UHC Choice Plus also, through Chase. I don't need a PCP referal to see Dr Fang, thats no issues and I just posted above that Ive started that whole thing. BUT when we did Hubby's approval with UHC in September, he was required to have a letter to submit to UHC from his PCP refering him for the surgery. That was something Dr Fangs office said was required to submitt for approval with UHC. So I don't have a doctor that I know of that would write a letter of referal for the insurance company.... Thats where Im thinking would they accept my OBGYN?

That seems odd to me. But who know's. In all my years working ins..If the provider you pick (Fang) is a covered provider with UHC..then a referral to see him or to have any procedures done by him a referral should not be required for the insurance, they do not care ,so to speak, all they look at is if you qualify. Especially if you meet the BMI and co morbids as required by the insurance company. In this case Fang is the referring Dr to the insurance company, based on his findings is what the insurance company uses. I used Dr. Newhoff for the RNY and Dr Weiner for BR in Oct and never had a PCP involved, especially since the ins is a PPO see who you want when you want not an HMO which require referrals to see specialists. Does Fang require, cardiologist & pulmonary as routine or based on co morbids? Again just curious, all I did was the pysch. exam and I was 52 yrs old at the time 5'7" and 330 lbs. Again best to you! Paula

I'll ask him about the whole referal thing when I go in for my initial consultation. All I know, is Hubby went to his initial consulation last year with Dr Fang (Same insurance as we have now)--- Hubby had no co-morbs. They gave him a list of things required before they even submit to insurance for approval. The list was: Referal letter from your PCP 2 years medical records Psych clearance Pumonologist clearance Cardiac clearance Dr Fangs office wouldnt even request for insurance approval untill all of those were done. Im just assuming I'd have to do the same. I called and made an appointment with someone my friend at work reccomends, she refered another friend of her's for WLS--- so Im hoping maybe she will do mine.

Darlene, You won't regret the waiting & the hassel what-so-ever. Once you are on the losing side with your husband, it will be all worth it. You are not as heavy as your husband was, so do not panic if your wieght loss is not as fast as his is. Just a little warning to be put out there to help ease some of the frustration. Good luck & it will be here before you no it Marilyn, the Bearlady