Need some advice

Ok, so I've been to Dr. Wynn for my consult, had every pre-surgery clearance done except for the life skills stuff, and now I'm at a stand-still. Where do I go from here? When I had my consult, I was told to go to PMRI. Then I was told to go to St. Francis. Now supposedly I can go to either. Any recommedations on where to take the diet and psych classes? There was a problem with my previous insurance (Aetna) since they wouldn't cover the Lap-Band. The last I heard from CHRIAS was to tell me this, even though I've left them tons of messages. Since then, my hubby's job changed and so did our insurance. We now have United Healthcare, which covers whatever type of surgery I want. But...isn't there always a but???...no one in CHRIAS is in-network, so we'd have to pay 30% of the surgery and all other visits. To top it off, I can't find an in-network bariatric surgeon in the area! Does anyone know of any docs who take United Healthcare? My insurance company will do something called a "network gap exception" if I can't find another surgeon within 30 miles and will cover it like Dr Wynn is in-network. But to do that, CHRIAS has to call them and give them information, such as tax id numbers and such. Another call, another time shuffled to voicemail, another call not returned. I might just have to go there in person. Any one else had these one-sided communication problems? Sorry to vent so much. I know I must sound like a whiny baby. But this has been such a long process, and I need to have surgery asap. My weight is really starting to take a toll on my health. I'd appreciate any advice about PMRI or St. Francis and any insurance tidbits you have to share. Thanks so much for letting me vent my frustration!

Hey there, I don't know about your particular insurance, but I do know that the closest Bariatric centers are downstate, MD and Philly... not great odds there huh? As for one sided conversations with CHRIAS, I've had some of those before just to find out that when I do get a live voice they have been working behind the scenes on the issue just haven't contacted me about it. I do trust all the surgeons in that office completely, but sometimes the communications breakdown can get quite upsetting. As for nutritional classes, I took them at St Francis because it was less expensive and I didn't feel I needed the extensive classes that PMRI had. Also, St Francis hospital has newer and better quality surgical equipment (heard this from a surgeon) I don't know what else I can let you know, but I will pray for an easy path, I know how frustrating things like this can be!!! I was just informed that my insurance (Cigna) will not cover my hospitalization because apparantly I wasn't sick enough when in extreme pain, dehydrated, unable to eat or drink without vomiting, and incapable of urinating on my own... they said my condidition did not warrant the level of care... argh... fun. HUGS, you'll get through this! Rachel

Sorry to Hijack, but Rachel, you need to fight them!!!!

Phoebe Go ahead and vent, that's what we are here for. Dr Winn and the entire CHRIAS team is worth the effort. Make another call, be persistent, leave msgs, whatever it takes. If they are able to make the phone call and have your insurance company pay for the procedure, I'm sure Misty or someone on staff will do that, too. They would want the business, and you will benefit as well. About the lifeskills and what hospital, you need to decide what works best for you. Some picked St Francis because it was less $ out of pocket. The Barix Center patients all praise their services, too. They apparently provide full service and follow up, too. Which type of surgery?, which Dr to use?, which Hospital? -- all big decisions to make. Don't feel badly about questioning the offices for more details. The more you read and ask, the more educated you become, the more smoothly your surgery and recovery and the more successful you will be. In answer to your question, I went thru PMRI Life Skills. I resented having to go, I made the best of it. It was very informative, but I can honestly say that I had researched this surgery fully and nothing they said or taught was new to me. I don't consider them a waste of time, most people don't do extensive research and need all those details. That's my two cents. Good luck in your journey, Dianne

*** Oops! Can't believe I spelled Dr Wynn incorrectly.

What Diane said. Keep trying Misty at the office. They're really busy and nometimes can't respond to non-urgent messages right aray.

Pheebs, Dr Wynn is worth the wait and extra aggravation. Please don't go to someone just because it is cheaper (I ended up being self pay due to my insurance) Keep persistant with Mistee (extension 3) they are just very busy. If you come to St Frances for our next support meeting (the 25th at 6:00) you will meet M.E. Sparks, the coordiator and the dietician. They will get the ball rolling for you. Once they get your name on the books they keep you informed. I hope this helps. If you have any further questions you can e-mail me. Good Luck Denise

Thank you all so much for your words of advice! I love this forum! Quick update: Misty called back and is working on gettin UHC to pay 100%. She said they have gotten United Healthcare to pay in-network for several patients because they don't have another in-network surgeon within 30 miles. Yay! I'm keeping my fingers crossed and praying. I do want to stay with CHRIAS and I feel I am in safe hands with Dr. Wynn. Now I just have to call St. Francis to set up my classes and wait to hear back from Misty again. Thanks again!

Pheebs, I have United Healthcare, where I work we have a choice of 3 different plans one is their HMO, and the other two PPOS that have 2 different co-pay amounts. I have the PPO with the lowest co-pays. CHRIAS worked with me 100%. Out of the $8000.00 that Dr. Wynn billed for my surgery I had to pay $250.00 and I owe Christiana a little over $1,000.00 for my stay and surgery. I will tell you though they will not pay for your PMRI or St. Francis visits for the pre-op classes. Everytime I walk through their doors it costs me $135.00 minimum. I had to pay PMRI aprox $1300.00 for the pre-op classes and appointments. Stick with CHRIAS, they are the best. Good Luck, Deanna

Have you asked your insurance company for a list of participating Baratric Surgeons. There are alot in the Philadelphia area. But there is a wait for many of them there and hoops that they want you to go through. Its not a easy process and I understand your frustration. Maybe since you have already gone the route that paying the 30% copay would be the best solution. I don't know your situation. I hope you find something that works for you. Don't let this get you down. There is always a solution to a problem...sometimes we have to look real hard for it. Good luck. Debbie