Has time stopped?
Catherine,
As a newbie to this board (I just joined a few weeks ago). Let me say, take a deep breath, process as information only, and try not to get too anxious about other folks information. I was so freaked out about everyone's postings. Everything seemed so hopeless, and so LONG..I was having anxiety over the length of this process and fears of getting rejected...I just knew this would happen to me-I am here to tell you, mine is just the opposite....I am not sure how much this will encourage you-but here is my story.
I went to my initial consultation with the suregeon's group (Dr. Sydney Appel-Decatur Ga-DeKalb Medical) on March 11, 2004. It was a four hour consultation. In addition to presentations, and a Q&A, they also provided me with the following data to ensure a smoother process with the insurance company:
Requirements were as follows:
Psych Exam (4 hours):
Perform & determine patients appropriateness for surgery
Complete MMPI-II test
Interview with Psychologist
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Diet Evaluation-Nutritionist:
Review pre-op guidelines
Review Post op guidelines
Discuss Protein Supplements
Discuss medication and vitamin restrictions
3 month post op review
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TSH Levels:
Thyroid Blood Test by Primary Care Physician
Testing must be done 6 months of insurance approval
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LETTER OF MEDICAL CLEARANCE:
Must state persons, height, weight, BMI & clearance for surgery by Primary Care Physician
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PHYSICIAN SUPERVISED DIET DOCUMENTATION
Must be office note or other documentation from a qualified professionsl to supervise a diet (office notes or weigh****cher booklets)
A summary letter is not sufficient and will not be accepted
Patient should have at least two (2) forms of documents
Attempts should be at least 6 months in length (each)
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SURGICAL REFERRAL:
This is required of all patients with a HMO or POS contract with their insurance company.
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PULMANARY CONSULTATION:
Determine if a patient has sleep apnea, or any other respiratory disease
Determine if a patient needs a breathing machine before surgery
Then of course, if any of the specialist found you needed an additional test, then you have to go through that process. In my case, the pulmanary exam showed I had a slightly enlarged heart (due to HBP)..I in turn had to go to a cardiologist for sxam followed by and echo cardiagram and Stress test. Those findings were normal.
Knowing all of this UPFRONT, I tackeled each requirement and sent the documentation to the Surgeons office. My paperwork was submitted to my insurance company on May 26th, 2004, and I was approved on June 8th,2004. I have my upper GI/Gallbladder testing tomorrow AM, and my pre-op appt with the surgeon next Friday. After that, I get a surgery date.
This took all of three months.and everything is flowing like clockwork here. Call your Insurance company upfront and find out what if any limitations they have, and know them upfront so you and your doctors can work as a team to get through this process.Stay CALM, DETERMINED, and FOCUSED on what you have to do.
Take Care and Good Luck!
Denise