Had My First Doctors Visit!

Ok. Yesterday I traveled a hundred plus miles and had my first bariatric doctors visit. My Doctor was nice and told me that there were steps I had to take before having the surgery which is required by my insurance company and it will take about 6 months. First I have to find a Nutritionist and schedule six consecutive appointments( one for each month, at five months I need to get a psychological exam, I need to lose five percent of my weight with in this six month period. I also need to get blood work done and consent from my cardiologist.

So my journey begins! Any and all suggestions are welcome. One ting thought..... I asked about the switch Doctor informed me that he will do a gastric sleeve first, if I need a revision then he will consider a by pass or a switch. So I guess I should change to the Sleeve site. You have all been so kind. Thank you! 

Congrats on getting started, but IMHO you should change surgeons rather than changing your choice of operation. You are the one who wil live with the outcome of this surgery, not the surgeon. Do your research and insist on the operation that is best for YOU. It is far, far easier to change surgeons than it is to fail at an operation (or succeed and then regain) and to get your insurer to pay for a second operation of any kind.

Larra

Dear Larra I have researched and my insurance will only do this surgery at there hospital with there approved surgeons. If I try to go some where else or with an unapproved doctor they won't pay for the surgery. I need the surgery so if I have to jump through insurance hoops then I guess I will jump. You do what you got to do!

I totally understand about insurance limitations. But - if this surgeon is telling you he could revise you someday to the DS if needed, he is implying that he knows how to do the DS and that it's part of his practice. Is this true? I don't know who your surgeon is and I have no way of knowing.

But, if you want the DS and are stuck with this insurance, why not challenge this surgeon (in a very polite and respectful way) by saying that you have researched your options and taken his recommendations into consideration and you still want the DS. He's an approved surgeon who apparently operates at the approved hospital, right?

I suggest that the truth will come out, meaning that he will try, again, to redirect you away from the DS, and if that doesn't work, will admit he doesn't do it.

Now, if that happens, and if the DS is listed in your policy as an approved bariatric operation, I think you could challenge your insurer to pay for the DS elsewhere based on the fact that it's a covered benefit that isn't available at the one approved hospital. Keep in mind that the DS has been a standard of care bariatric operation since 1991 (and done in the USA since 1988) so you aren't requesting anything experimental or unproven or unreasonable.

What I'm trying to say in my long winded way is that you might have more options than you think. We have seen other people get their insurers to pay for care out of network when there is no surgeon in-network who provides the appropriate care. It's not your fault if their very limited panel doesn't provide the care you need.

Larra is right.  If your surgeon knows how to do the DS (and that's a big IF, since there is 50 or so in the world who do a real DS), then they can do it as one surgery unless you aren't healthy enough to be under anesthesia for  2 hours (but it only took my surgeon 90 minutes).  I'm guessing he's either trying to do something "easier" that he'll get the same money for or he doesn't do it at all.  Don't be afraid to question that, just as you would anything else as a customer.

Two procedures means twice the risk for complication, twice the risk for infection and twice the recovery.  Add to that twice the copays and make sure your insurance doesn't have the "one WLS procedure per lifetime" clause, and know right now what they require for a revision, for there are many sleeve patients that are here because they didn't get the results they were hoping for.

She said on the sleeve forum that she is high risk with breathing issues Asthma and Sleep apnea and that he wants her under for the least amount of time. That is why he wants to do the sleeve. I think she should listen to her Dr. IMHO.

Hi Lara! I sent you my insurance company name and web address via email. Thanks for the help. I pray you find some good news for me.

Seems to me the insurance company should fight for her to get the whole DS rather than pay for 2 ops.  Or maybe they plan on denying the second.  This is just another way to package the old 2-stage DS.  It's sad that people are being forced to fail with the sleeve to get the DS.  It's just wrong.  They don't make the RNY people fail with the lapband first!