Possible Insurance Issues

Well, I went to Barix Clinic today. Things did not get off to a good start, I set my alarm for 7:00am to give me plenty of time to get ready and get there early, however my alarm did not go off and luckily I woke up on my own at 8:20. So I got there right and 9:00 and the info session had already started. It was weird sitting there, with the Dr. basically telling us all if we didn't lose weight we were going to die. And went over all the negative things about being fat. Sitting through a session like that kind of makes you feel a bit worthless. Since I was the last person in I would be the last person seen for the 1-1 consult. The nurse was very friendly and cordial, she asked me ALOT of questions about my personal and family medical history. Then finally, after waiting for an hour and a half I met with the Surgeon, Dr Kam. He was friendly, but wasn't very helpful after he realized my insurance was BCBS Community Blue PPO. Apparently, they work with all types of BCBS...but ofcourse they don't actually work with mine. At this point I couldn't help but be heated. When I spoke with the rep over the phone she told me they have worked with my insurance before and didn't see any issues. I felt like this was a waste of my time. I mean I took 4 hours off of work, had to pay my co-pay all for you to tell me you "might" not take my insurance. He said the trip wasn't useless because I got some good information. I disagree. Well anyway, after he left a counselor who has already had the surgery came in. She looked awesome! She showed me some before and after photos. I asked her questions and she was able to answer them and was very helpful. She gave me a packet of info and told me what my insurance required from me. I was a bit confused because I felt like Dr. Kam totally blew me off. According to the packet I still need do a psych consult and get a letter from my PCP and get an ECG. When I got back to work I made an appt with my PCP and my Psychologist. I wanted to update them on my plans and let them know I will be needed letters from them in the near future. After my visit to Barix I decided I would like to call around and check out some other options. I have consults with CORI, and the St. John's Hospital's program next week. I am also going to an info session at U of M in November. I am confident I will have this surgery soon. I know I have good insurance, I picked this insurance on purpose and I pay pretty high premiums to maintain it. I would hate to think all my hard work has been for nothing.

Ok, before you do ANYthing else. Call your insurance company and ask them specifically if the surgery is covered. Also ask if pre-op testing and follow-up appointments are covered. I'm going through Hurley in Flint and they actually gave me the exact procedure and diagnosis codes that they would use when submitting the final bill to my insurance. This was very helpful in getting specific information about what my particular policy covered. Don't rely on what a surgeon's office says. Make sure you know for certain that it's covered (and what exactly is required) before you start the process. Good luck! Pam

Call the U of M Adult Bariatric Program. I am the Admin Asst and would be glad for you to come to one of our sessions. 734-647-6685. We do take your insurance. Visit our website at www.med.umich.edu/bariatricsurgery and look over our criteria! I would love to hear from you SHannon

Have you called St Mary Mercy in Livonia. I had my surgery there August 28th and I am doing wonderful. I know they take your insurance. They are so helpful and wonderful. Their number is 734-655-2692. Angie, Paula and Dr. Zeni are the best. I was back to work after only 2 weeks. I have only heard horror stories about St Johns and Cori. This place is also closer for you. Might be worth the call. Stacey B

I am SO sorry your consult left a bad taste in your mouth! All I can suggest is attending seminars of different programs until you find a surgeon YOU like! I personally went where I loved the surgeon....after all it is not his "program" that is operating on me! I do have a letter my PCP wrote and other than this letter the only other thing I had to do was get bloodwork done and a psych eval. BCBS comm blue PPO does NOT do pre approvals, but my rep at CORI told me EXACTLY what my letter from PCP needed to contain in order for it to be paid. Well surgery was in March and BCBS paid 30k and I was responsible for about 1k due to co pays and deductibles. Here is a copy of what my PCP wrote: TO Whom it MAy Concern: I have been Jennifer E's primary care physician since January 2000. She has suffered with obesity since the age of 14. She has been on several different diets for 12 consecuitive months at a time and she herself stating she has been on a diet her whole adult life. All her attempts have been without long term successful results. She is also under my care for asthma, stress incontinence, back and joint pain. Her current weight is 355, height 66inches and BMI 57.36. I have discussed bariatric surgical procedures and risk involved with her at length. She understands and will comply with post-surgical requirements. I recommend her to undergo bariatric surgical procedure and feel it is medically necessary for her morbid obesity. If you need any further information regarding Jennifer E please contact my office. Sincerely, Steven J. Thibault, M.D. Best of luck to you.....you WILL find the right surgeon I promise and when you do......you will know it ;) Jennifer -115 so far