I Am A Newbie, But Not Really

Hi All  I'm a newbie here on the boards! I have been reading comments and advise of the good the bad and the ugly for quite some time now. and i must say the postings can really be a great help...NEways i finally joined and am now in the process of getting my page up and running...i have lot of information that i still need to insert, and in time i will. I have just been scared to get started, i even convienced myself that i just didnt know how. I guess it was all a whole bunch of crock, i was just letting my fears of getting started and really meeting everyone get to me. Its been a hard toll just trying to get along with life, you see, i live in New Orleans and since the storm it seems to have changed everything, even myself. I am trying really hard not to be introverted, but i swear the experiences down here has brought on so much to deal with. I was seeking to have surgery (God say the same) @ Vista Hospital in Baton Rouge by Dr. Teresa Klainer...i have  a lot of stuff already done (my phycological evaluation, all my pre op testings and have a Sleep Study scheduled for next week. Even started my liquid diet. OK I Was All Excited!!! then guess what? My insurance Tenet Choices pulled the plug on the only "Center of Excellence" Hospital that i can utilize (insurance stipulations:(( and now denies "Out of Network) the storm was not our fault) Why can't they understand that...our city is still struggling with medical facilities? NEways i need and want some really good friends right about now. Just call me Dreamz cause for right now thats all it is.

Dreamz, hi! I lived in N.O. before the storm and relocated to Covington after. I had my surgery at Ochsner in N.O. by Dr. Kennedy. They are now a Center of Excellence I believe. Would your insurance consider letting you go there? Hang in there, sometimes this process can be very long. Jen

Hi Jen ...its so good to hear from a homegirl!...i wi**** was that simple for me, because yes your are right, Ochsner is a "Center of Excellence" but do not take Tenent Insurance..what bad luck is that?...So you say hang in there...ooooOK, I hanging...LOL... just praying i dont fall, Thanks, Dreamz

Hiya Dreamz, Google "Center of Excellence" and do some reading on just what goes into that proclamation. There are some standards, but it's also an agreement by the hospital to accept the rate of commensation that Medicare will pay. When using private insurance and not Medicaid, the designation really isn't always pertanent. There's a new bariatric program at Our Lady of the Lake in Baton Rouge and the two surgeons working it are also veterans of Vista Surgical Hospital -- also where I had my surgery. This isn't a commercial for those doctors or that program, but a hope that you will evaluate all your options and feel good about where Tenet will approve you. If you do choose to come down here to Baton Rouge -- or Lafayette or Lake Charles -- let me know. I would love to come by and check on you while you are here. Onward! Frances

Hi Frances i did exactly as you suggested Sis, and i did get a wealth of information concerning this "Center of Excellence" thing, but unfortunately none of it is going to help my case. I am medicare and i can ONLY utilize center of excellence facilities. Although Medicare is a national program, and you can even travel to another state for your procedure. (you must have "Out of Network Benefits" or be straight Medicare without a handler) Which i do not have as of yet. Since i am Medicare that is contracted through Tenent Choice i am locked in locally. Fortunately there is a loop-hole for me by becoming an "Out of Network participant (which will cost me an additional payments directly to my contractor),  which i more than willing to do for the time being, of course,to have my way...the only thing is it will cause me a delay untill they open their cases, which is once a year mid-November...Well, at least i see light at the end of the tunnel...even though i will still have to get final approval from my insurance company once i obtain a surgical hospital. i just always stay prayed up Sis. The reason why i stated Vista Hospital in Baton Rouge because believe it or not that is the only board certified "Center Of Excellence" that deals with medicare in the state of Louisiana. Yes Oschner is certified but will not accept my insurance...in act they are not even on the program...they deal with more private insurance companies. I am hoping all goes well and i do get my approval at Vista very soon...i will keep you posted and i would LOVE for you to come see me Sis...it would make my day! You are such a Sweetheart!Thank a bunch, Dreamz P.S. I sure hope that you are doing well Sis, and that you hubbie is on the mend getting better!...i'll keep you in my prayers I am almost sure that the agreements that the hospital that accepts the rate of commensation that Medicare pays plays a very important factor too, but also... Medicare has become more focused in recent years on quality outcomes for Medicare beneficiaries and it is believed that this directly contributed to the inclusion of the Center of Excellence requirement. To become certified Center of Excellence, the hospital or institution must: Perform at least 125 bariatric surgeries per year collectively.The surgeon must have performed at least 125 bariatric surgeries by him or herself over a lifetime and perform at least 50 per year. A center must also report long-term patient outcomes.  The center must have a dedicated multi-disciplinary bariatric team that includes surgeons, nurses, medical consultants, nutritionists, psychologists and exercise physiologists.

There's hope, sis. The centers getting COE does change over time, but there's also a movement of practices who do not want the COE status even though they meet those requirements. Please check with Dr. Chu in Lafayette and Dr. Merriman in Shreveport. When I last checked, these programs had COE status. Dr. Chung's practice at Womens and Childrens in Lake Charles easily meets the volume requirements and might consider it in coming years. Also, push Tenet Choice to give you more options on this hard-and-fast rules. There's always a way for determine folks like you. Thanks for asking about me and hubby. He's not standing or walking yet, but progressing with transfer and wheelchair skills. After countless surgeries, I have blockages and pains caused by adhesions and scarring. I'll be having surgery week after next in Baton Rouge. I hope it's an in-and-out surgery because we "old folks" have a bouncing, energetic preschooler to care for at home. I won't be going to Vista -- I guess because this might be daysurgery -- but I love that place and give them high marks on everything, except PR and image marketing. They do more to publicize their bariatric program, but this doesn't affect the quality and personal care you get when you are a patient there. I spent a very difficult week there in 2005 and I can't say enough good about the staff there. Please keep me abreast of your progression. Onward! Frances

Hi!  I just wanted to mention to you that Dr. Hargroder did my surgery.  I believe is practice is a COE and he is located next door to Vista.  He is a very skilled surgeon and I have not had one problem since my surgery on May 23rd.  Good luck to you.  Things will work out -- through the power of God.  He seems to make things just fall in place!

Thank you so much Ashley, i wish...i did do reasearch on Dr. Hargroder awhile back...and yes he is very sharp!...i even completed his online physological testing, but got cut off at the knee caps yet again...i've been running all over the place trying to get in where i can fit in...but just keep getting myself all excited over and over again just to keep getting a pin in my balloon...its all about my local insurance...so until i get my policy changed to Out-Of-Network i will continue to keep running into dead ends....but HeY...i am working on it!