My Journey...

My journey started three years ago when I had finally made up my mind to have the surgery. Since I didn't have insurance I applied for disability and began jumping through all the prerequisite hoops that go along with it. What a rocky road that was! Well, long story short, I was finally awarded disability (Medicare) in May 2003 and immediately scheduled an orientation with the Weight Management Center at St. Charles General even though my Medicare wouldn't kick in until October of that year I figured I would get a head start and get the ball rolling. Well October rolls around, my Medicare kicks in, I sign on with Tenet (because my Dad was with them and they are great about prescriptions) and I was ready to begin. All of a sudden I'm told that the WMC is moving to because St. Charles General was being sold. "Where are you going?" I asked. "We don't know yet. Maybe either Baptist-Memorial or Touro. We'll let you know as soon as we move and are settled." Ok fast forward to February 2004, they've moved over to Touro. I begin my pre-op testing. Of course Touro is a Humana hospital so they tell me I have to go elsewhere for my testing but they think that Medicare will pay for my surgery there regardless. Wrong. After going through days and weeks of poking and prodding I'm told that there's nothing they could do as long as I was a Tenet patient. They suggested I try going to Dr. Klainer's private practice because she usually operate's out of Lindy Bogg's (Mercy) which is a Tenet facility. I do that and she informs me that her office isn't set up to handle bariatric patients but here's a diet and some Zoloft, lose 100 pounds, come back and see me. WHAT?!?!? I'm like "look if I could do that I wouldn't need YOU!" It's now summer 2004 and I am called to California for the summer for a job (I'm still allowed to make so much per year on disability) so I put off the whole thing partly out of disgust and partly out of necessity. So in the Fall of 2004 I get back in town and call the WMC at Touro and ask them what could I do to have this surgery. I was told (off the record) that if I switched my insurance to Humana there wouldn't be a problem. I go through the arduous process of switching to Humana and in February 2005 I begin pre-op testing AGAIN. Then I am told there is some sort of problem and Medicare won't pay for any surgeries at this time. I give up. I throw my hands in the air and fall into a deep depression. The next thing I know, it's now end of August and Katrina strikes. Major whirlwind of horrible things: Evacuation. My dog dies. My Dad DIES. Try to rebuild my life. It's now December and I call The Surgical Specialists of Louisiana in Covington and schedule an appointment. I come in and meet with Dr. Warden and he puts me on a liquid diet until surgery. "It's a diet especially for patients who are 14 days prior to surgery but stay on it until we schedule your date because I want you to shrink your liver. A few good martinis will do that Doc." He doesn't get it. I move on. So I began drinking my shakes as my Mom and I look at houses throughout the greater Baton Rouge area in hopes of moving (we later decide not to). I then get a call from Dr. Warden's patient advocate (fancy name for the girl who makes sure you can afford your surgery) two weeks after beginning this liquid diet. She tells me to stop the diet right away because----guess what? Yep. You got it! Humana now requires all patients to be on a medically supervised diet for at least six months before "they'll even THINK about approving" the surgery. Oh F*CK! What do I do now? If I could follow a medically supervised diet and keep it off I wouldn't be in this situation. Time for another "off the record" conversation/plea for help. I'm told by Miss Patient Advocate that (since Katrina) Tenet has been sending patients to them because they no longer have a bariatric surgeon in the area and that they are signing off the surgery. So..."if you switch to Tenet everything will be peaches and cream!" Um, ok. Sure. Ring ring ring. "Hello Tenet. I'm sorry I dumped you for Humana. Will you consider taking me back?" Well I guess my planets were aligned properly because they welcomed me back and now I was set. Or so I thought. Now here I am getting ready---it's February 2006---just about to go have that sleep test done when---RING RING RING! "Hello this is Miss Patient-Advocate-I-Really-Don't Give-A-Sh*t-About-You calling to inform you that Medicare will no longer pay for the surgery at our facility unless we achieve the rating of "Center For Bariatric Excellence". How nice. Medicare really cares about me. They care so much that even though I may DIE before I finally have this surgery, they won't pay for it unless it's at a hospital that has kissed their ass! "Um ok Miss Patient Advocate--WHAT THE HELL DO I DO NOW?" She calmly but icily replies: "we might have it in six months, so you can either wait or go to the nearest hospital that has it and that would be in Lafayette." "LAFAYETTE? That's over three hours away!" "Yes, Lafayette. Goodbye." Ok so I plunge headlong into another deep depression accompanied by a binge that I had been on since my Dad's funeral. What was I going to do? I am getting to the point of being non-ambulatory, breathless, and in daily pain. So I see this commercial for Vista Surgical Hospital in Baton Rouge, an hour northwest of New Orleans. It features all of the staff from Dr. Martin's Weight Management Center. A miracle? Surely it has to be! So that's where Old Martin and his staff landed when the waters subsided! (It sure would have been nice to get a phone call as a prospective former patient, but I digress.) I call and make an appointment. It gets put off three times because I have no one who could rearrange their schedule to drive me up to Baton Rouge since I can no longer drive. In the meantime I keep calling them, asking "ARE YOU SURE you accept Tenet, Medicare, and Medicaid?" "Yes Ma'm we do." was always the stock reply. Ok so my Mom, my Uncle, and myself make the journey to Red Stick. We leave home at 7:30 am, pick up my Uncle, and arrive at 8:45 am for my 9 am appointment. Right before you pull into the hospital parking lot you pass a KFC all-you-can-eat Buffet. How nice. You walk into the cozy, lavishly furnished reception area and on the TV is Martha Stewart showing us how to properly ice a cake. Then muffins. Then cookies. Lovely. "This is a weight loss hospital?" I check in and am given a clipboard which has a stack of forms, releases, and various questionnaires, attached to it. All told I would say there were six thousand two hundred and twenty eight forms to read, initial, and or sign. Copying "War and Peace' letter for letter--in Russian--would have been more fun. Ok, next a cute young orderly comes to get me for my weight, blood pressure, etc. We walk what seems like a mile for me and inches for him. I am weighed. I am disgusted, humiliated, and defeated in one quick glance at the read-out on the electronic scale. I trudge back to my seat. I am told I am waiting to see Dr. Paige. I chat with some of the ladies in the waiting room, all of whom are post-op and I listen to them rave about Dr. Paige: "Oh he is so good. He's so cute. He's so young." I reply "Well I don't care if he looks like Brad Pitt or a guest on Jerry Springer, as long as he knows to how use a scalpel and make stitches, I'm fine." So it's now 9:45 am and we eye the clock, no sign of Dr. Brad Pitt anywhere. 10 am, nothing. 10:15 am I ask the receptionist: "Oh he's on his way." 10:45 am nothing. 11:15 am nothing. "Oh he's coming. He knows you're his first patient of the day." I say "His FIRST? Is he hung over? What's going on?" She says: "I'm sorry Ma'am but I don't know where he is---he may have had an emergency. I'll call and check." It's now NOON. Ok I settle down, go back to my chair. Oh look!---Rachel Ray is on TV now showing me how to cook Beef Stroganoff, Poached Pears with a Cherry Demi-Glace, and a Goat Cheese, Bacon, and Arugula salad all in 30 minutes! What a sweet girl! And how thoughtful of Vista Weight Loss Surgical Hospital to educate me in the Culinary Arts whilst waiting for my Dr. Brad Pitt...Ok it's now 12:15 pm. I am now dealing with an irate chain-smoking Mom, an impatient elderly Uncle, and a fed-up with life Me. Enter Dr. Brad Pitt. Young, tall, skinny, gangly, and ski-nosed Dr. Brad Pitt. Not my idea of good-looking but hey, he's my Doctor not my date at the prom. And so very very young. Then I suddenly realized "F*ck! I'm about to be examined by Doogie Howser!" So we go into one of the examining rooms and while he's got my tongue depressed he blithely lets an "oh by the way, sorry I was late" slip out. He then goes on to explain that he was "driving in from New Orleans". "Oh really. It was only three hours and fifteen minutes." Ok so everything in my exam is going great for what it was. We discuss surgical options. Diets. All the usual stuff. Then I let slip that I was a Medicare patient. Well you should have seen the color drain from Doogie Pitt's young face. "Well technically we can't do all of your testing here because Medicare won't pay for your surgery because we haven't achieved the rating of "Center For Bariatric Excellence." "WHAT?" He goes on: "Yes, here's a prescription for all the tests you'll need. You can't do them here because I don't think Tenet/Medicare will pay for them if done here. You could try and see but I don't think they will. Anyway, come back here when you get them done. Then you can see Dr. Raum who is our M.D. and he will give you a diet. We might have the rating by this summer, but Katrina really messed up our progress with that. The best thing you could do is get your testing done and then we could transfer you to Lafayette. They have the nearest hospital that has the rating..." "STOP! I don't wanna hear those words again." Ok, so that's where I am today, June 12th, 2006. Do I begin testing yet again and then transfer all the results directly to Lafayette or do I keep my June 30th appointment at Vista, hoping that a) Dr. Raum is better at showing up for scheduled appointments and b) Vista may have good news for me? Nahhhhh. I think I'm gonna cut Vista out all together. They're just a middle man. The lure of going there was just so I could get everything done in house. Oh well that's not to be for me. I'm gonna get my tests done here and fast forward them to Lafayette and hope for the best. Go**** feels good to get all this down on paper. Now at least when friends ask me when I'm going to have the surgery I can send them this long-winded missive and rest assured, they won't ask again! LOL Jonne ;)

Just to let you know, somebody read this. I think I read it three times. Before or after you have a date scheduled somewhere in the US, you might consider attending our OH chapter support group meetings in Baton Rouge. They are the fourth Thursday of each month at the BREC part at Independence. We aren't tied to any one particular doctor's practice and there are no fees for membership. I wish you well, Frances - Interim OHLA Chapter Leader

Wow! Thanks Frances! Can you send me more info? Jonne

You have another reader! And you are wise to skip Vista. I had my surgery there and they are great folks but you spend a lot of time waiting on doctors who don't show up half the time. My last two visit where like that. All I heard was they are coming they are coming. The last time I was scheduled to see my surgeon I waited and waited and finally said is she in the building or what. Oh yes ma'am she is in surgery. So I say why the hell did you schedule me to see her at 10 if she had surgery? She says oh that wasn't me and I say yes it was. I wrote your name down this time because this is not the first time it has happened. She swears it wasn't her what ever. Any way the ladies that do the scheduling and work the front don't work for the Touro doctors so they don't really care what they schedule you for. So it's a gamble every time you go whether or not you will get to see someone. They will schedule you to come on the days the doctors are not even there. I have taken to calling them back several times to make sure it is a good day to come. Well enough about that. I hope you can get this done and everything works out for you. Also I hope to see you at the next meeting. Tina

Thanx Tina! Do you belong to Frances's group? Jonne

Yes ma'am.

Whew! You have had quite a trip! It will make it all the sweeter when you are on the loser's bench! Hope everything works out well. Patricia

Thanx for the kinds words Patricia! Jonne

Jonne, Yep, another reader!! I can tell you my story isn't too much different... Started out with Great West (American Lifecare PPO), and Dr. R. O'Connell.... well thank GOD that I was told "oh sorry, you need a 6 mo diet" and I got a temp job at Ochsner.... because it wasn't till later I found out how MANY complication patients of his ended up at my second surgeon's office.... Fast forward 4 months, took a staff hospital job ON a bariatric unit... more than 10 co-workers had already had WLS and I was thinking that this was my "golden ticket" so... while waiting for the insurance to start.... Katrina hits and NO ONE was able to tell me WTF I would be able to do then... 3 weeks after Katrina (keep in mind I'm living and working in the hospital, my home was destroyed)... I get a verbal "ok" on my appeal and then 4 days later... a denial in writing because I have no 6 mo diet. In tears, I pursue it a bit longer before I just couldn't stay in New Orleans.... Now, months later, I'm on COBRA from that same insurance, doing the 6 mo diet.... repeating a sleep study (if I'm lucky enough to find a good team for it)... and hoping again for approval.... sadly, they have made a new co-pay of $5000 for the surgery! Oh well, one day I will get through this, and I will be proud to say how hard I worked to get what I needed to save my life. Hugs, from one who understands the runaround.... Kat

Forgot to say, my COBRA is Humana - Ochsner Employee's Plan.... I still can't believe that after living and working in the hospital immediately post Katrina, I still got denied my appeal to the HR Benefits department of their self funded program... I guess that's the biggest reason I had to leave... no loyalty despite the extreme conditions I endured to remain loyal to them during a difficult time!