6 MONTHS WITH PCP DONE! NOW?

Hi Everyone! I have finished my 6 month with my PCP. Now for the scary part. I have only till the end of the year to have my WLS. My husbands insurance will drop his work at the end of the year. My husbands factory is moving to Mexico by 2009. It doesn't mean he will have a job till then. He could possibly get laid off sometime next year.  My insurance denied me the first time and said that I only needed the 6 months with my PCP. I hope they don't come back with something else. I'm trying to stress to everyone I don't have a lot of time. I know most of you have been through something like this. I have worked so hard for something that could save my life. I will fight! So if any of my OH family has any info. for me I'll take any advise. Terri

i fought for 3 yrs with darn medicaide i know what your going through marie

Marie, I wish you all the luck in the world.3 years is a long time. Is there a chance your surgery will happen soon? Keep us in touch will your journey. If you need to vent we will be here to listen. Terri

I know what you mean...... I'm trying to have a revision......I had the VBG 10 yrs. ago.  I started trying to get my insurance approval over 2 yrs. ago and they said that I'd have to see my PCP for 18 months.  What they failed to tell me was that I also had to keep a food log and some other things, so after the 18 mos. I was denied again.  I figured that was probably it.  A few weeks later I get a letter in the mail stating that I needed to complete a bunch of stuff over a 6 mo. period.....see my PCP 3 times; see a dietician that they appoint, 6 times; see a psychologist that they appoint, 3 times and take a test for her (which is 567 questions, I think); and also go to a therapy group session once a week for 12 weeks.  I live in Kokomo and all of this was in Indy.  I finished my last thing, which was my last appointment with the Psychologist on Oct. 8th.  She still has not written up my report and sent it in......I've been calling her every week (which she told me to do), but until today I did not get to talk to her.  She called back and said that she would probably be calling in a verbal okay this Thursday and she'd have the report written up by next Monday.   The main problem with getting this done is that our insurance runs out at the end of the year because we have MPlan and they are no longer going to be doing group insurance.  I'm not sure if we'll have Anthem or something else yet, because we haven't heard from the insurance people yet.  Also, I want the same surgeon that did my first surgery and he's usually pretty busy, so I'm not sure if I'll be able to get him or not, since I don't have alot of time. Do you have MPlan or some other insurance?  I know that they are supposedly trying to push the MPlan people through as quickly as possible (but obviously the Psychologist wasn't doing this). I'm sorry to hear that your husband is losing his job within the next year.  Are they going to have any insurance at all after the end of the year?  If I were you, I'd probably just try to keep on them, even if you have to call them everyday.  It's definitely a scary situation when you're trying to get something like this done and they act like you have all the time in the world.  They only told you that you have to see your PCP for 6 months......nothing else?  I'd call them asap and find out for sure that you don't have to do any thing else.  I don't know anything else to tell you.  Hopefully if you have nothing else you have to do that they will let you know real soon if you're accepted, but I'd definitely call and make sure.   Good Luck, Candy

WHAT INSURANCE DO YOU HAVE. A LOT DEPENDS ON WHO IT IS AS TO HOW LONG IT CAN TAKE IF YOU HAVE EVERYTHING THEY NEED.  GOOD LUCK VICKI

Hi Everyone, I do have M-Plan. My husbands work is suppose to get another company, but so far they have had any luck with a provider. I'm happy to here that they are trying to get M-Plan people in quickly. I sure don't want to start all over. I did get all of my new info. to the insurance today by fax. I also sent all the info. to my surgeon. So I guess I'll know something soon. I have done everything else including my psychologist evaluation. Terri

Terri, Good! I'm glad that you have all of that stuff done.  We had to go through alot more hoops than you seem to have to......which is great for you.   I know that there was around 13 in my therapy group trying to get this stuff done before MPlan runs out.  I'm hoping that it'll happen for all of us.   I think I saw that you're going through Dr. Jones?  She's at St. V's isn't she?  I know with our MPlan we had to go through Clarian, so that might be the difference as far as all of the stuff we have to go through.  Even though we have the same insurance company, we probably still have different insurance plans according to the companys we work for.   Again, good luck and keep us posted. Candy

Candy, I started all of this process back in March. I researched all the different surgeries for a long time. I just wanted to make sure I was making the right choice. I wish I would of decided a long time ago maybe I would have been done by now. I just hope the insurance company don't find anything else wrong. I hope everything goes smoothly for you from now on. GOOD LUCK. Dr. Jones is at St. V's. She also did my daughter-in-law's surgery. She was great. Well it will be nice to know we are not  alone in this process. Keep us posted on you as well. Terri

Terri, I know what you mean about deciding a long time ago.  Of course I did decide a long time ago, but then MPlan required 18 months of supervised weight loss, so it might not have mattered.

I'm glad you're comfortable with Dr. Jones.  Alot of people seem to like her.  When I had my surgery in 1997, her husband used to talk to our support groups about plastic surgery.  I had Dr. Huse then and I'm hoping to have him again, because he was a very good surgeon also.  He also did surgeries at St. V's too.  When I was first trying to get it done, MPlan would not let me go to him even if they had approved me then, because Clarian North wasn't done being built and I had to go to a Clarian Hospital, and he didn't start doing surgeries at Clarian until Clarian North was done.   Hopefully, we'll both get it done soon.  I started my stuff last March also.  Good luck again and I'm sure we'll talk about this again. Candy