pre-op needs your help with insurance for DS
i'm not sure if this poster has been here, but thought i'd link y'all to her. http://www.obesityhelp.com/forums/rny/4654422/Your-experienc e-Is-it-worth-it/#38614426. she needs a DS.
That would be me. I want to have surgery with either Dr. Stephen G. Boyce or Dr. K. Robert Williams, both at Tennova Center for Surgical Weight Loss in Knoxville, TN. Both are experienced with DS, accept medicare (but not my type of medicaid - amerigroup), and it's also located close to my aunt with whom my bf can stay during the hospitalzation after surgery so we don't have the cost of hotel.
Medicare will cover 80%, and amerigroup (medicaid) should cover remainder. The catch? There is not a single surgeon in TN that takes amerigroup that does DS. Not. One.
I have a BMI of 60...well, I lied, it's actually more. I tell people I'm 5'4" but that's with my shoes on. So I guess I have a BMI of 62. I have PCOS, which keeps me packing on the pounds and make it hard to lose anything. I also have high blood pressure and insulin resistance. And, not that I guess it matters too much, but also hypothyroidism (I do take meds for it). I really don't want to do a RNY because weight loss can be iffy if you're really big. I'm worried I'll end up still being obese and unable to lose the rest of the weight. I don't want to go through a surgery and still end up being obese. I also take NSAIDs daily for knee pain and back pain. I can't take that with a RNY.
What should I do? I'm going to call amerigroup tomorrow but I have never tried to see a doc out of the network. I don't even know how hard it will be or where to begin!
BTW, I love your name.
Apply and get denied. Then work on appeals. READ your policies and see what they really say. MOST policies will let you go outside your area for procedures that aren't done where you live. I do know of one DSer who was on disability who moved to a city with a DS surgeon expressly so she could have the DS. Look for alternatives.
You are right. You need the DS. Now you have to fight for it.
I think I found one. They don't normally take amerigroup, and so they told me when I called them yesterday, but I scheduled to go to their seminar anyway...they called me this morning for my insurance info, I told them medicare and the amerigroup they didn't take, he said "hold on, I'm going to talk to the insurance coordinator" - he came back and said they would take amerigroup as a secondary insurance, which is what they are for me! Excited! It's the Tennova Center for Surgical Weight Loss in Knoxville, TN. Really excited!
