Insurance problems

First let me say hello to all of the members on this site, I have been coming to this board for well over one year now, but just recently constructed a profile. Now on to my issues.... I have BCBS HMO, Northwest suburban IPA. I live in illinois and I have complied with thier instructions as far as being on a 1 year drs supervised diet. I saw a nutritionist for 1 year. Now that I am at the end of the time, I got refferred to a surgeon at Rush hospital Dr. James Madura. Well now my dr asked for a referral for him through the insurance company and they denied it saying that I can go to Loyola, but loyola does not do Gastric Bypass anymore due to the high death rate they were experiencing up to 10% of thier patients did not make it. They do however do the lap band. I can not stress how much I do not want the lap/band. I do not want that device in my body. I know many people have gotton it and are doing just fine, but I do not feel it is for me. Is thier anyone in illinois who is dealing with these issues. Please help .

The best thing I can tell you is you need to write an appeal letter to your IPA! And to BCBSIL asap..! My PCP knew Edward Hosp didn't do Lap Gas Byp and got a referal thru a different surgeon close by. You need your PCP also to write a letter as to why you would be better off having Gas Byp vrs Lap band and she/he needs to state your reasons and act like they agree or are on board. Good luck....I experienced many o'problems w/HMO BCBS il! The best is to stay informed and keep calling and talking to them! Don't act sheepish! xoxoxoxojenn

I too am seeing Dr. Madura, who I think is the best. His nurse Samantha is beyond wonderful and understanding. Did you talk to her yet? You should. Why would your ins. want you to go to a place with such high statistics for complications. Tell them no. If you're approved for a gastric bypass then they should send you to a hospital that does them. Explain to them that the Doctor, recommends a certain type of surgery, in my case it is the RNY. You know I have had a really bad day, because of my insurance. I'll post it if you want to read it. Channelle, it is so sad that we have to go through these hoops for these insurance companies. Our Nation is in an insurance crisis right now, because of the insurance companies and what they get away with. In my opinion yours can have a WLS done for less money if you go to Loyola. Find out if they have ever sent a patient with your group coverage to Rush. Ask questions, and read about the new HIPPA, and laws on discrimation. Don't give up because I know Dr. Madura is a great Surgeon. B.Stuart

Channelle have you looked into another surgeon? I went to Dr. Fred Tiesenga, he's in River Forest he does the RNY there are 3 of us on the board who used him. CHeck and see if he takes your insurance.. And if a surgeon has a 10% death rate, what the hell is he doing wrong? that is an alarming high number to me..

Channelle, I just went on the BCBS website and Alexian Brothers Hospital is in your network. Suburban Surgical Care does WLS there, and I believe they take BCBS HMO. There number is 847-255-9697. You can also go on the BCBS website and find all the hospitals within a 100 miles of you and then research which one does WLS and check out the surgeons at each one. You have gone through all of this don't give up now. I'd also continue with your supervised diet and weigh ins so that if it takes a few months to get the process going they cannot come up with that your diet was too long ago and you need to start over. Good Luck, D

Thank you everyone for your suggestions, this has been a long hard road, but I refuse to give up. My PCP called me friday and told me that I won't have to have the surgery at Loyola, but the Ins Com is makinging me see him first then he will give me a referral to an outside surgeon that does GBS which of course I want to be Dr. Madura. I got the referral sheet Saturday, but of course the surgeon at Loyola offices were closed. I will call today ASAp to make an apt to meet with him. I had an apt next Monday with Dr. Madura I wonder should I keep it.