Can Someone Anyone Help Me!

All of my insecurities are setting in and i just need some reassurance please!i felt that i have it all figured out but as the days are passing i am getting scared. i am having Out-of-Network problems which is mainly due to my "Center-of-Excellence hospital issues. i have gotten everything done pre-op except my consult with my nutritionist which i also need to have done at Vista Surgical Center. Gosh this is so hard to explain, but if your read my profile you'll get a better understanding of whats going on. As of yet, no i have not been OK'ed for surgery, but if we can get this hospital thing finalized maybe i could get a date. I have a plan to change my policy but now i am afraid that even that wont work. My insecurities concerning everything is in overdrive and i am so sad because just today my insurance company told me that the reason they are having issues is because Vista wont accept what they are willing to pay. I just dont understand it all. Is there anybody out there who is Tenent Choice Insurance and dealing with the same situation of just needing the required hospital to get their surgery done. Thanks,Dreamz

I don't have Tenet choice, but I can tell you that the insurance game is the pits!! I spent 4 years fighting insurance companies to get my surgery.... I finally did in March.... persistance pays off, don't give up!!

Thanks so much Kat for the encourgement...sometimes it really does start to get me down...and when i hear from strong people like you it does help me...wow you really hung in there a long time...koodos to you sis!...Dreamz

It was tough, and Katrina to boot.... we relocated and ended up in Texas... but I really could not be happier here now that I am a patient, and a bariatric coordinator :)

Honey, stay strong!!!  Sometimes you really have to fight the insurance companies.  I had an exclusion and was told by a lawyer there would be no way to fight it.  Guess what?  I fought it and won.  There was no way in hell I was going to not fight, after all this was my health we were talking about.  For me the exclusion was no weight loss surgery or any treatment for weight loss.  Ok fine, I was fighting for my health.  I steered away from the weight loss issue and focused on my health issues.  I took the cost of my medical treatments and the cost of the weight loss surgery by an far it was cheaper for the insurance company to pay for the surgery versus almost bi weekly visits to my PCP, GI specialist, all the scopes that I had to have done plus the alternative surgery for my GERD which the surgeons said would be a failure do to my weight.  (The insurance company was willing to pay for that surgery) all the issues that I dealt with concerning being overweight.  It was a no brainer to cover my WLS....I guess when I started throwing the $ around they came around.   18 months since my surgery I have only been to my PCP once with an exception to my yearly appt. I am off all my medications.  Weight loss surgery saved my insurance company lots of money.   Basically through my long story.....stay focused and fight for what you want.  Don't let the insurance company win.  They are in the business unfortunetly  (sp) to make money not  cover issues for our health.  I think they have things wrong.  Sometimes it takes money to make money..... Stay strong!!!  Emotions are hard during the fight but so worth it when it is said and done. 

Wow thank so much Jody...you guys are giving me a lots of confidence...what i am learning here is to keep plenty of strength and perserverance...and dont go down without fighting...LESSON LEARNED!!!..Thank You! ...its like anything else in life, when you really really want something you have to focus&pursue it to the fullest...i dont know why i didnt keep that in my perspective ...thank you so much for reminding me...you had a very good stragedy Jody, and it paid off for you and i am so happy for you Sis...Dreamz

Oh by the way, Jodi (sorry not Jody) you look admazing girl!!!

I wish you the best of luck in your surgery.  I attended a support meeting at Dr. H's office.  It seems to me that most of their patients have the sleeve.  Dr. H does do the duodenal switch so, I jumped through all the hoops only to learn (on my way to sign the papers to pay for the surgery) that Dr. H will not do the DS on a patient age 65.  Medicare pays for it in a Center of Excellence but it seems that Vista being Center of Excellence  will not let the particular surgery be done in their hospital on anyone over the age of 60.  So, all of the hoops were for nada.  The surgery I have chosen has been done in Center's of Excellence all over the country on patients 68, 72 and even on at age 78 but for some unknown reason Vista won't do it.  So, here I go looking for a doctor who will do the duodenal switch on a 65 year old (there are a number) who has medicare and uses a "Center of Excellence".   Anyone with any information about a surgeon who does the duodenal switch who uses a Center of Excellence please let me know. I have heard a lot of good things about Dr. H and Vista.  Just not an option for me.  Again, I wish you the bery best outcome for you and your surgery. 

Hi Toogie thanks you too for the encouragement also...Yea i always heard nothing but good things concerning Vista Hospital...so i am so sorry things did not work out for you as well...i wish you luck in finding a new doctor who will have all the qualifications that you desire...that in itself is not an easy task either...my doctor is Teresa Klainer and she will be  doing a Laproscopic RNY on me just using the Vista facility...well hopefully, God say the same! ...but i do have some knowdledge of Dr. Hardgrover and Dr. Drake Bellenger who works over there and have heard great things from them also...they are wonderful doctors...i think you are going to have a lot of problem with the "Center of Excellence" situation also because thats the problem....Vista ia the only one right now that accepts medicare...i know their are other doctors...like Dr. Warden who works onthe northshore along with Dr. Lavin's office but then again there you go...that "Center of Excellence problem again...they dont have the hospital crediantials at Omega...and the other hospitals they utilize are not medicare ...at least not with Tenent...if youare just medicare i would tell youto check in with Oschner...i think they do take medicare...but i am not positive ...just check...but what i do know is that they are a  "Center  of Excellence" ...just didnt work for me since they didnt have Tenent ontheir plan..its worth looking into it...Good Luck!  Dreamz

I hope that things are rolling right along for you.  Just with a couple of phone calls I have located doctors out of state who use Centers of Excellence and will do the DS for me.  One is from this area but has his practice in another state.  They are both outstanding surgeons and don't discriminate against people because of their age.  They take the older patients on a case by case basis.  I have an appointment to see a surgeon, not an assistant or seminar,  in August.  In one day I have been able to get better service out side of this state than I have been able to do here in Louisiana over the last year.   I guess I am just learning that home grown isn't always the only or best ssource and/nor value.  I am sorry but I am just very frustrated with the wls options in Louisiana.  But there again this state is always a decade behind all the others.  

Wishing you much success in your weight loss endeavors.  Toogie