Feeling FRUSRATED!!!!

I have my 1st appt with a surgeon (DR. Steele) at Hopkins-Bayview on August 27.  I received the thick packet in the mail and reviewed it vrey thouroughly.  One part says to verify with your insurance company what kind of coverage you have for WLS.  So the other day I called United Health Care and spoke with someone who transferred me to another department so that I could get some specific questions answered (what do I need to do to qualify,etc), anyway I spoke with a rep who told me that UHC requires that you get pre-quilified for the surgery and that he could start that process then if I wanted and I thought - great!! It's nice to be able to do something while waiting to see the surgeon, etc.  So anyway he asked me a bunch of questions and said that I needed to obtain info on my BMI (48.1), co-morbidities (none), previous weight-loss attempts and a 5 year h/o obesity.  Then he gave me a reference # and I felt happy that the process had been started.  The only glitch was that he said my surgeon was not in the plan and that I should pick someone else from the practice, so... Today I called the office and spoke with a lady named Lillian and she was very upset that I spoke with this man and said "you shouldn't have done that you need a 6-month supervised diet history and now they are going to deny you and you've just cost yourself a lot of time in getting approved".  SHe also said how it was going to take alot more work on their end (the surgeon's office) to appeal my claim once it's been denied.  Then she asked me why I called then that is what she is supposed to do - she seemed very upset - and told me that she had to go becuase I interupted her when she was with patients.  Just so you know - I just called the office number and she just happened to answer the phone.     So now I don't know what to do - I thought that I was doing the right thing and I've got the surgeon's office person irritated with me and maybe sabotaged my insurance approval..Any advice??

Thanks for listening to my LONG vent!!! Kendra

Kendra...maybe you should pick another doctor since UHC told you that Dr. Steele was not in your plan. I would find one that is in my plan. I am having Dr Von Rueden at GBMC. They took care of all the insurance things for me. I did not have to contact the insurance company. They set it up that way because they know just who to talk to at your insurance company. Hope you can get things straightened out.

Kendra, I would have to agree with Gail to find another surgeon that is within your network. Going outside of the network could cost you more money in the end.  Also, sounds to me like they need to change their information packet because if they don't want you to call your insurance company then it should not be in the packet. (Just my opinion) I had my surgery with Dr. Roe at GBMC and they handled everything, I did not have to speak with my insurance company at all. The only thing I had to do was call to see if the surgery was covered, once they said yes the surgeons office took over and did everything else. Quick, easy and painless. Good luck though. Kelli

Kendra, Dr Schweitzer at Johns Hopkins Bayview is in their plan. I have United Healthcare and they were wonderful to work with. I did not have to do all the pre-op monkey business or jump through any hoops to get approved. I would call Dr S's office to see what they can do. Bayview and some of the bariatric doctors there are part of the United Healthcare network. Good Luck with your journey. United Healthcare was totally great to work with and they were very helpful during the whole process.  Carol

I also have United Health Care. i had my wls with Dr. von Ruedin. I never had a bit of trouble. I can't imagine UHC giving anyone that qualifies difficulty with approval. Check out DVR at GBMC. I think you will be pleased.

Hi. I am having my surgery with Dr. S and they have been wonderful to work with. Why don't you see if he is in your network. I agree with everyone else, it is hard to go outside your network. Jo

I would also highly recommend Dr. Schweitzer at Bayview. Also, you might want to ask for Lillian's supervisor, and/or tell Dr. S about the problem. You can even email him, and he replies pretty quickly. See his info at www.smallscar.com I think Lillian is relatively new there, so it is important that you notify the supervisor or speak to someone to let them know how she made you feel, or that the correct info was not being passed to you. Also, the nursing assistant for Dr. S and Dr. magnusson is Pat Jordan; I assure you she will check in to your complaint as well. They are very good about that. Best of luck on your journey! Hang in there. It can be a long and tiresome process, but ?here is a light at the end!! ~~ Trish

FYI, Dr. Steele is new in the practice group with Dr. Schweitzer.  Dr. Scheitzer did my band as an out of network doctor (the hospital is in network, but he is not with BCBS)  It really did not cost all that much more, so if you like Steele, talk through the specific finanical numbers with her.  DOn't let a few dollars change your plans.   (If I am remembering the packet correctly, it suggests that you ask the insurance company what there policy requirements are, etc... more about what they require, not that you give them information on you.  This is probably a very subtle difference, but i think the offices prefer to handle communication themselves, since they know what insureres want to hear.) Good luck!  :) Barbara