New job I am a precert

New job I am a precert nurse. I had the pleasure of authorizing my first WLS. I am torn as I want to push the DS but that is not professional. The first procedure I did auth was for a sleeve so I hope if it is not ultimately the solution they can switch to a DS…………… It will be difficult for me to auth lap band as it was not successful for me and I hate for someone to go through the process only to be discouraged. I have to remember I am not the doctor and they are submitting the data not for my opinion but for authorization from the ins company……………

Good for you! I guess you'll have to bite your tongue on some of those approvals. Just don't assume a lightwight only needs a band or a sleeve, some of us have the comorbidities to benefit and do well with the DS too....I know you know that though.  : )

--gina
 

Which insurance company do you work for?

I don't think that would be fair to my company or professional but I will say they are much more pro WLS then the last company I worked for.  They truly care about the pt/mbr.  In fact in most case if all the criteria is met I can approve on my own.  In the instance I mentioned my supervisor felt it needed to be submitted to a medical director as she felt 3 wts across 3 months from 2 doctors did not meet the 3 month medically supervised wt loss criteria.  Thankfully the MD made the decision in favor of the mbr which made me happy.  The company I worked for prior even if someone had problems with their gallbladder after the fact they would immediately jump to a denial if the procedure was not covered by the ins provider to begin with.  I must say it is a lot nicer working for an ins company who has the mbr best interest at heart!!!

No problem, I was just inquiring since you brought it up. 

Just remember, their journey is not your journey.    Do your job to the best of your ability!

The sleeve has worked for a lot of people I know.  They haven't had any weight regain.  How a person handles it, is up to them.  You have no control over it.  

This journey called life can be difficult at times and as always I will do my job to the best of my ability with a non biases opinion.  Your insight is very helpful.
Thank you
Donna

I would never have posted this on a WLS board, much less a DS board. You have your thoughts and feelings, just like each of the people you are approving/denying. To take your personal bias into account is extremely unprofessional, and posting it on an open forum is lightyears beyond that. If you are a Lexus dealer, do you want to approve someone for a new Caddy? Um, no.

This is wrong, and I hope you have it pulled.

I disagree I am try to remain unbiased, to do my job to the best of my ability.  I appreciate the support and the very helpfyl insight posted as I found it helpful and that is what the site is for.  I shared my struggles and appreciate the insightful responses I have received.
Donna