delays and learning patience
(deactivated member)
on 8/1/08 12:56 pm - Park Forest, IL
on 8/1/08 12:56 pm - Park Forest, IL
Hi,
Well today I finally got a callback @ 4pm from the HMO office at my clinic, they faxed the referral for my sleep study to the hospital, so I call the hospital and of course there was no one there, so I left a message. Well, the hopsital just called to schedule my sleep study.....Sept 29th is the first available appt. So now Monday I can try to schedule the follow up appt with the pulmonologist who is supposed to be backed up till November, maybe they'll squeeze me in since they canceled me 2 times. Now instead of submitting my paperwork to the surgeon to submit to my ins co in Sept. looks like it'll be nov-dec before everything is done, no idea when I'll have wls...is there still hope for this year before Christmas???? . Also having problems between my clinic and my insurance finding out where I can go for my psych eval. Have to deal with that next week, as the ins co is mailing me a 4 page list of providers but they can;t tell me which one does eval for wls!!??!! The clinic really doesn't care who I go to as long as the administer a ??? minion??? test???? and fax the results to them. what the heck is a minion test?? Oh well.. I always said I needed more patience but this is not how I wanted to learn it.
Paulette
Well today I finally got a callback @ 4pm from the HMO office at my clinic, they faxed the referral for my sleep study to the hospital, so I call the hospital and of course there was no one there, so I left a message. Well, the hopsital just called to schedule my sleep study.....Sept 29th is the first available appt. So now Monday I can try to schedule the follow up appt with the pulmonologist who is supposed to be backed up till November, maybe they'll squeeze me in since they canceled me 2 times. Now instead of submitting my paperwork to the surgeon to submit to my ins co in Sept. looks like it'll be nov-dec before everything is done, no idea when I'll have wls...is there still hope for this year before Christmas???? . Also having problems between my clinic and my insurance finding out where I can go for my psych eval. Have to deal with that next week, as the ins co is mailing me a 4 page list of providers but they can;t tell me which one does eval for wls!!??!! The clinic really doesn't care who I go to as long as the administer a ??? minion??? test???? and fax the results to them. what the heck is a minion test?? Oh well.. I always said I needed more patience but this is not how I wanted to learn it.
Paulette
Paulette,
Im sorry to hear of all your problems with referrals and appointments and trying to get all your things done to get your date. I just went through all of this myself and just recently got my date.
First of all, THE SLEEP STUDY, Im not sure what insurance co you have, but you dont necessarily have to have it done at a hospital. You can check with your insurance company and see if they cover any of the "Sleep Centers" I used Merit sleep center and they were great, My insurance covered them no problem. You can also try any other hospital that your insurance covers, and ask for a referral to there. Sept 29th is a long way away to wait I agree. I looked up park forest on the map and it looks like you are pretty far south, but Merit has alot of locations and Im not sure how far you are willing to travel, if you go to their website you can read all about them and see their locations. You may be willing to drive a little distance if you can get it done sooner. I know I called and got in within a couple days, and the report was faxed the next day. The center was awesome, great queen sized beds, large fluffy pillows, a plasma TV, recliner, huge bathroon, and it was decorated like a nice hotel.
You could also call your pulmonologist and see what centers they reccommend. Im sure they have more than the local hospital and maybe they have pull with the center and can get you in sooner. It seems like a pulmonologist who is backed up to Nov, is too busy. What about if you needed them before hand. THe other thing is if you have already had your consult and only need the sleep study and the results, maybe you dont need a return visit, maybe you can talk to him over the phone and get the results and if you need CPAP they will refer you to home health anyway.
Is the CLINIC you are speaking about your primary care office or your WLS surgeons office? If it is your Surgeons office, they should be able to refer you to a psychologist that they prefer so you can get the right eval. I have read on these boards that people have had their psych eval only to be told it was not the right kind and they had to do it over. You dont want that for sure! My surgeons office arranged for the psych consult right in their office. They referred me to the pulmonologist too, and were able to get me in sooner to see him becasue it was for WLS. They have been very accommodating.
If the clinic is your primary care office, I would call your surgeons office and ask for help and advice on who to go to. They usually have someone dedicated to getting the patients approved and know all the ins and outs of the system. IT is sooo sad that we have to play games with the insurance companies and be a royal pain towards them and be our own ADVOCATE.
I called my insurance company at least everydaty and raised Holy H@## every day becasue they kept giving me mixed messages and no one knew what they were talking about. Plus I gave up on talking to whoever answered the phone and right away ask for a supervisor.
I know this is alot of information, but I dont want to see someone else go through all I went thru to get my surgery approved. I truely believe that ins companies make it so hard so you give up and then they dont have to cover it.
Good Luck and if I can be of any help, please ask!!!
Im sorry to hear of all your problems with referrals and appointments and trying to get all your things done to get your date. I just went through all of this myself and just recently got my date.
First of all, THE SLEEP STUDY, Im not sure what insurance co you have, but you dont necessarily have to have it done at a hospital. You can check with your insurance company and see if they cover any of the "Sleep Centers" I used Merit sleep center and they were great, My insurance covered them no problem. You can also try any other hospital that your insurance covers, and ask for a referral to there. Sept 29th is a long way away to wait I agree. I looked up park forest on the map and it looks like you are pretty far south, but Merit has alot of locations and Im not sure how far you are willing to travel, if you go to their website you can read all about them and see their locations. You may be willing to drive a little distance if you can get it done sooner. I know I called and got in within a couple days, and the report was faxed the next day. The center was awesome, great queen sized beds, large fluffy pillows, a plasma TV, recliner, huge bathroon, and it was decorated like a nice hotel.
You could also call your pulmonologist and see what centers they reccommend. Im sure they have more than the local hospital and maybe they have pull with the center and can get you in sooner. It seems like a pulmonologist who is backed up to Nov, is too busy. What about if you needed them before hand. THe other thing is if you have already had your consult and only need the sleep study and the results, maybe you dont need a return visit, maybe you can talk to him over the phone and get the results and if you need CPAP they will refer you to home health anyway.
Is the CLINIC you are speaking about your primary care office or your WLS surgeons office? If it is your Surgeons office, they should be able to refer you to a psychologist that they prefer so you can get the right eval. I have read on these boards that people have had their psych eval only to be told it was not the right kind and they had to do it over. You dont want that for sure! My surgeons office arranged for the psych consult right in their office. They referred me to the pulmonologist too, and were able to get me in sooner to see him becasue it was for WLS. They have been very accommodating.
If the clinic is your primary care office, I would call your surgeons office and ask for help and advice on who to go to. They usually have someone dedicated to getting the patients approved and know all the ins and outs of the system. IT is sooo sad that we have to play games with the insurance companies and be a royal pain towards them and be our own ADVOCATE.
I called my insurance company at least everydaty and raised Holy H@## every day becasue they kept giving me mixed messages and no one knew what they were talking about. Plus I gave up on talking to whoever answered the phone and right away ask for a supervisor.
I know this is alot of information, but I dont want to see someone else go through all I went thru to get my surgery approved. I truely believe that ins companies make it so hard so you give up and then they dont have to cover it.
Good Luck and if I can be of any help, please ask!!!
EILEEN
(deactivated member)
on 8/2/08 12:04 am - Park Forest, IL
on 8/2/08 12:04 am - Park Forest, IL
Thanks for all the info Eileen,
The problem is I have BCBS IL POS (works like an HMO) and have to have a referral from WellGroup(my pcp & Clinic) for everything and they won't or don't want to refer offsite unless they don;t have someone who can do the particular thing. Because they don't have any Bariatric specialists I was able to get a referral to UIC for Dr. Vitello for my consult, but WellGroup is requiring that I have all preop tests/appts done through them, which was ok with Dr. Vitello. I am/was supposed to go back tosee Dr. Vitello mid Sept with all the required results/paperwork and then he would submit for approval for the wls through BCBS and when that came back approved he would schedule surgery. Orginally he though sometime in Oct would be my RNY.
The nurse from the sleep study did tell me about the wait list and put me on that and said they do get quite a few last minute cancellations, so I will be sticking close to home and stopping caffeine today (which I needed to do anyway) so if I get a call at the last minute I'll be ready to go. Monday when i call the pulmonologist I am going to insist they get me in as close to the 9/29 date as they can, I know they have to wait for the results but how long does that take? The other thing I don't understand is my husband had sleep apnea and surgery for that but he never had to go to a pulmonologist just and ENT. So that will be my next questions when I call the doc on Monday..BTW I see my pcp on Tuesday so I will be loaded for bear when iIsee him, I have all my notes and info lined up so I can get some answers from him. He really is a great doc and usually makes things happen for me. It's just hard to get throught he gatekeepers to get to him but since I have an appt he will be acaptive audience LOL!!
Thanks for all your advice, that is what I love about this site and the people here, everyone is so supportive and has tons of info and ideas to get around the roadblocks. In the meantime I have lost 45 pounds since December, 20 pounds since my consuult with Dr Vitello May 9th. I posted on roll call this am about my eating problems this week, but I know it is all stress related and will work out I just have to be consistent.
hugs, paulette
The problem is I have BCBS IL POS (works like an HMO) and have to have a referral from WellGroup(my pcp & Clinic) for everything and they won't or don't want to refer offsite unless they don;t have someone who can do the particular thing. Because they don't have any Bariatric specialists I was able to get a referral to UIC for Dr. Vitello for my consult, but WellGroup is requiring that I have all preop tests/appts done through them, which was ok with Dr. Vitello. I am/was supposed to go back tosee Dr. Vitello mid Sept with all the required results/paperwork and then he would submit for approval for the wls through BCBS and when that came back approved he would schedule surgery. Orginally he though sometime in Oct would be my RNY.
The nurse from the sleep study did tell me about the wait list and put me on that and said they do get quite a few last minute cancellations, so I will be sticking close to home and stopping caffeine today (which I needed to do anyway) so if I get a call at the last minute I'll be ready to go. Monday when i call the pulmonologist I am going to insist they get me in as close to the 9/29 date as they can, I know they have to wait for the results but how long does that take? The other thing I don't understand is my husband had sleep apnea and surgery for that but he never had to go to a pulmonologist just and ENT. So that will be my next questions when I call the doc on Monday..BTW I see my pcp on Tuesday so I will be loaded for bear when iIsee him, I have all my notes and info lined up so I can get some answers from him. He really is a great doc and usually makes things happen for me. It's just hard to get throught he gatekeepers to get to him but since I have an appt he will be acaptive audience LOL!!
Thanks for all your advice, that is what I love about this site and the people here, everyone is so supportive and has tons of info and ideas to get around the roadblocks. In the meantime I have lost 45 pounds since December, 20 pounds since my consuult with Dr Vitello May 9th. I posted on roll call this am about my eating problems this week, but I know it is all stress related and will work out I just have to be consistent.
hugs, paulette
Good Morning!
Here are a few ideas, not in any particular order because I am soooo NOT a morning person!! LOL!
Pulmonologist VS ENT: When your husband went to see his PCP about his ?sleep apnea, the dr may have assessed his symptoms and figured they were related to his anatomy. Then you need an ENT to be able to fix the problem with surgery.
We see a pulmonologist because when someone is MO they have alot of lung issues. SO not only is the pulm. concerned with our sleep apnea ( tells them how we MAY do with waking up from anesthesia and the ability to get us off the ventilator), they are concerned with our lung capacity and funciton to make sure we are able to clear our lungs after surgery. CLear lungs=no pnemonia post op. That is why we have to use the incentive spirometer ( that breathing machine type thing they push you to use all the time) to prevent lung collapse and pneumonia among other things. Sometimes with their testing (pulm) they are able to see that our function isnt as good as it could be so they can reccommend treatments for pre or post op that will help us out.
For example, my pulm reccommended that I use my inhalers every day for a week before surgery {i usually only use them when I am sick} to increase my lung capacity and keep them open.
The sleep apnea part is usually discovered as part of their workup too.
Pulm: Does he have any partners you can see earlier? I have seen partners in all the specialists I have been to because of scheduling issues.
Psych: Talk to your PCP and remind him of how important it is to find the right Psych so that the ins will accept their eval. Maybe for this one part he will let you go see Dr. Vitellos Psych becasue it is such an individualized eval just for WLS. This may help avoid a denial. ( those ins co are always looking for a reason to deny). Also, if Dr. Vitello's office has ins specialists, they may be able to help you find the right specialist who they KNOW will do the right eval.
General Advice: The squeeky wheel gets the grease!! Call the sleep study dept every day at least once. That way they will UNDERSTAND how important this is to you to get it done ASAP.
Make sure they know it is for surgery clearance not just for a reg sleep apnea eval, sometimes that gets you in sooner too.
Well, I am sure you are tired of reading for now, so I will sign off. I just know how frustrating all this scheduling and testing can be. I also know that ins co do not care about us, they only care about the almighty dollar.
I wish you well and much luck for a speedy APPROVAL!!!
If you have any more questions, please ask, that is if you are not afraid of me by now!!! LOL!!!
Here are a few ideas, not in any particular order because I am soooo NOT a morning person!! LOL!
Pulmonologist VS ENT: When your husband went to see his PCP about his ?sleep apnea, the dr may have assessed his symptoms and figured they were related to his anatomy. Then you need an ENT to be able to fix the problem with surgery.
We see a pulmonologist because when someone is MO they have alot of lung issues. SO not only is the pulm. concerned with our sleep apnea ( tells them how we MAY do with waking up from anesthesia and the ability to get us off the ventilator), they are concerned with our lung capacity and funciton to make sure we are able to clear our lungs after surgery. CLear lungs=no pnemonia post op. That is why we have to use the incentive spirometer ( that breathing machine type thing they push you to use all the time) to prevent lung collapse and pneumonia among other things. Sometimes with their testing (pulm) they are able to see that our function isnt as good as it could be so they can reccommend treatments for pre or post op that will help us out.
For example, my pulm reccommended that I use my inhalers every day for a week before surgery {i usually only use them when I am sick} to increase my lung capacity and keep them open.
The sleep apnea part is usually discovered as part of their workup too.
Pulm: Does he have any partners you can see earlier? I have seen partners in all the specialists I have been to because of scheduling issues.
Psych: Talk to your PCP and remind him of how important it is to find the right Psych so that the ins will accept their eval. Maybe for this one part he will let you go see Dr. Vitellos Psych becasue it is such an individualized eval just for WLS. This may help avoid a denial. ( those ins co are always looking for a reason to deny). Also, if Dr. Vitello's office has ins specialists, they may be able to help you find the right specialist who they KNOW will do the right eval.
General Advice: The squeeky wheel gets the grease!! Call the sleep study dept every day at least once. That way they will UNDERSTAND how important this is to you to get it done ASAP.
Make sure they know it is for surgery clearance not just for a reg sleep apnea eval, sometimes that gets you in sooner too.
Well, I am sure you are tired of reading for now, so I will sign off. I just know how frustrating all this scheduling and testing can be. I also know that ins co do not care about us, they only care about the almighty dollar.
I wish you well and much luck for a speedy APPROVAL!!!
If you have any more questions, please ask, that is if you are not afraid of me by now!!! LOL!!!
EILEEN
(deactivated member)
on 8/2/08 12:35 pm - Park Forest, IL
on 8/2/08 12:35 pm - Park Forest, IL
Hi Eileen,
You are a treasure trove of info and I appreciate it. Earl saw an ENT because the pcp was sure he had sleep apnea befopre the testing. Earl would fly out of bed many times during the night choking. I thought he had swallowed saliva or something. And you're right our pcp said Earl had enlarged tonsils, uvula and chronic sinus infections.
I think the only reason the endo. ordered the sleep study for me is because DH told her I snore and wake up 2-3 times per night. I also have Asthma but it is controlled with meds. I think I wake up either because of my back hurting or because I am on a diuretic. So mabye because of the asthma I have to see the pulmo. I just looked at the papers from Dr. Vitello(wl surg) he requires clearance from a pulmo. so maybe it is because of the M & wls.
Wellgroup only has 1 pulmo, the other left the practice which is why there is a backup.
BCBS of Il is requiring I go to one of their psychologists not the one from Wellgroup, because my mental health coverage is through a place called Solutions and that is the only way they cover the $$ of the eval. WellGroup said that is ok with them as long as the Psych i see does the minion testing(?) still haven't found out what that is. But I think I will call Dr. Vitellos office when i get the list from Solutions because maybe someone they have used is on the Solutions list.
And no i am not afraid of you, very greatful for another opinion and ideas how to get through this mess. : ) Paulette
You are a treasure trove of info and I appreciate it. Earl saw an ENT because the pcp was sure he had sleep apnea befopre the testing. Earl would fly out of bed many times during the night choking. I thought he had swallowed saliva or something. And you're right our pcp said Earl had enlarged tonsils, uvula and chronic sinus infections.
I think the only reason the endo. ordered the sleep study for me is because DH told her I snore and wake up 2-3 times per night. I also have Asthma but it is controlled with meds. I think I wake up either because of my back hurting or because I am on a diuretic. So mabye because of the asthma I have to see the pulmo. I just looked at the papers from Dr. Vitello(wl surg) he requires clearance from a pulmo. so maybe it is because of the M & wls.
Wellgroup only has 1 pulmo, the other left the practice which is why there is a backup.
BCBS of Il is requiring I go to one of their psychologists not the one from Wellgroup, because my mental health coverage is through a place called Solutions and that is the only way they cover the $$ of the eval. WellGroup said that is ok with them as long as the Psych i see does the minion testing(?) still haven't found out what that is. But I think I will call Dr. Vitellos office when i get the list from Solutions because maybe someone they have used is on the Solutions list.
And no i am not afraid of you, very greatful for another opinion and ideas how to get through this mess. : ) Paulette
(deactivated member)
on 8/2/08 12:06 am - Park Forest, IL
on 8/2/08 12:06 am - Park Forest, IL
Hi Christina, I've been meaning to PM you, glad you & Calvin are fine.
I did get on the waiting list for any cancellation and as of today I am switching to decaf. I needed to do that anyway. It just feels so ovewhelming sometimes all the hoops, I've been trying since last Dec to get the wls., but what will be will be.
Hugs, Paulette
I did get on the waiting list for any cancellation and as of today I am switching to decaf. I needed to do that anyway. It just feels so ovewhelming sometimes all the hoops, I've been trying since last Dec to get the wls., but what will be will be.
Hugs, Paulette
Paulette, Try and see if your surgeon has a preferance and who to see, if not, I know other hospitals have other sleep groups and phychs. Your Insurance co. should be able to give you any info that you need, I can't say enought about mine, they helped me all the way, so I had answers before I needed them. Once everything comes together for you, it will go fast.
Hugs
Hugs
(deactivated member)
on 8/2/08 12:08 am - Park Forest, IL
on 8/2/08 12:08 am - Park Forest, IL
Hi Lisa,
Thanks for your ideas too. I posted a response above to Eileen on why this is such a mess due to the type of ins I have and the clinic where my pcp is.
Thank you, Hugs, Paulette
Thanks for your ideas too. I posted a response above to Eileen on why this is such a mess due to the type of ins I have and the clinic where my pcp is.
Thank you, Hugs, Paulette
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