Kalamazoo insurance question:)
HI...
I have an insurance question... My aunt is trying to get approved for surgery, and she cannot find a PCP arounf here who will do weight loss for 6 months with her. She's super frustrated, and about to give up on it. Her insurance covers mostly Borgess stuff, but I think she'd be willing to go out of network. Anybody around Kalamazoo have issues with this? She made appointments at 3 different places, and they either stuck her with a Nurse practitioner( which her insurance won't count) or told her the PCP in the office who deals with weight loss can't schedule anything until Late september. Can anyone suggest a Dr. for her? Thanks a bunch! She is my FAVE Aunt, and I hate seeing her so frustrated.
Kathy
I have an insurance question... My aunt is trying to get approved for surgery, and she cannot find a PCP arounf here who will do weight loss for 6 months with her. She's super frustrated, and about to give up on it. Her insurance covers mostly Borgess stuff, but I think she'd be willing to go out of network. Anybody around Kalamazoo have issues with this? She made appointments at 3 different places, and they either stuck her with a Nurse practitioner( which her insurance won't count) or told her the PCP in the office who deals with weight loss can't schedule anything until Late september. Can anyone suggest a Dr. for her? Thanks a bunch! She is my FAVE Aunt, and I hate seeing her so frustrated.
Kathy
I would suggest she go ahead and make the appointment with the primary care physician for the end of september. In the meantime, she should start documenting everything she eats - include amount, calories, fat grams/calories, fiber and protein. She should also log any exercise she does. This will give her a good start when she see the doctor. I would also suggest she ask for any cancellation. The end of September is really not that far away.
What type of insurance does she have? What is her BMI.
If she has Blue Cross and has a BMI over 50 - the 6 months is waived.
What type of insurance does she have? What is her BMI.
If she has Blue Cross and has a BMI over 50 - the 6 months is waived.
Delores Moore
it's never too late 
it's never too late 
Doesn't she have a PCP of her own? If not, then she needs to find a doctor she is comfortable with and will support her decision to have WLS. The 6-month diet is important right now, I know... but the bigger picture is that she NEEDS a doctor for her after care and it's best to find someone she likes right now.
Also -- make sure she has a printed copy of the exact guidelines her insurance requires for insurance approval. Not just the diet history, but everything. (Just call the number on the back of her insurance card and request that information to be mailed to her.) Then she needs to use that written list as her checklist for getting everything done. That list should also include the exact requirements for what the diet documentation needs to include -- monthly weights, blood pressure, nutrition counseling/guideance, exercise counseling/guideance, discussion of Rx diet pills, etc. It's easy and not really a big deal that the doctor can do in a 15 minute monthly appointment.
If all else fails, check with the surgeon's office to see if they have a program she can go through. Hurley in Flint has a program through the Health and Fitness Center --- I had a referral from the surgeon (my "doctor" requirement) and then met each month with the same person at the Fitness Center (he's an RN and personal trainer and nutritionist) and he recorded all the information required. At the end of my 12 months of appointments, he faxed the reports to the surgeon's office and I was scheduled for sugery within 3 days.
Good luck to your aunt.
Pam
Also -- make sure she has a printed copy of the exact guidelines her insurance requires for insurance approval. Not just the diet history, but everything. (Just call the number on the back of her insurance card and request that information to be mailed to her.) Then she needs to use that written list as her checklist for getting everything done. That list should also include the exact requirements for what the diet documentation needs to include -- monthly weights, blood pressure, nutrition counseling/guideance, exercise counseling/guideance, discussion of Rx diet pills, etc. It's easy and not really a big deal that the doctor can do in a 15 minute monthly appointment.
If all else fails, check with the surgeon's office to see if they have a program she can go through. Hurley in Flint has a program through the Health and Fitness Center --- I had a referral from the surgeon (my "doctor" requirement) and then met each month with the same person at the Fitness Center (he's an RN and personal trainer and nutritionist) and he recorded all the information required. At the end of my 12 months of appointments, he faxed the reports to the surgeon's office and I was scheduled for sugery within 3 days.
Good luck to your aunt.
Pam
My Recipe Index is packed full of yumminess!
Visit my blog: Journey to a Healthier Me ...or my Website
The scale can measure the weight of my body but never my worth as a woman. ~Lysa TerKeurst author of Made to Crave
Thanks Pam!
She does have a PCP, but he doesn't deal with weight loss, so when she tried to get an appointment with the Dr. who would, she's run into scheduling issues with them...Plus two different Doc's kept her in the waiting room for more than an hour and a half with no explanation, so these aren't really Dr's she wants to go with. She is so frustrated! I will definetely pass this info on to her...
Kathy:)
She does have a PCP, but he doesn't deal with weight loss, so when she tried to get an appointment with the Dr. who would, she's run into scheduling issues with them...Plus two different Doc's kept her in the waiting room for more than an hour and a half with no explanation, so these aren't really Dr's she wants to go with. She is so frustrated! I will definetely pass this info on to her...
Kathy:)
Kathy -
Her PCP doens't have to "deal" with wieght loss or specialize in medical weight loss techniques. She just needs to go in, get weighed, get her vitals taken, talk about her diet, tell him what she's doing for exercise .. and make sure he writes all that stuff down. Done. It's best to have all that information with her other regular medical chart. There's really no need for her to find a new PCP for just the 6 month diet documentation. It's litterally that... "diet documentation". .... just a doctor documenting what she's doing.
Pam
Her PCP doens't have to "deal" with wieght loss or specialize in medical weight loss techniques. She just needs to go in, get weighed, get her vitals taken, talk about her diet, tell him what she's doing for exercise .. and make sure he writes all that stuff down. Done. It's best to have all that information with her other regular medical chart. There's really no need for her to find a new PCP for just the 6 month diet documentation. It's litterally that... "diet documentation". .... just a doctor documenting what she's doing.
Pam
My Recipe Index is packed full of yumminess!
Visit my blog: Journey to a Healthier Me ...or my Website
The scale can measure the weight of my body but never my worth as a woman. ~Lysa TerKeurst author of Made to Crave
Dr. Melissa Oiken is a PCP AND a weight loss specialist in Kalamazoo. She is at Pro-Med in Portage. You can also call Gwen at Dr. Vereseman's office and ask what PCP they would recommend.
I'm surprised that they won't accept nurse practitioners as they are much less expensive than a PCP and do more holistic approaches to weight loss.
Good luck to your Aunt!! you are a great niece.
Deb
I'm surprised that they won't accept nurse practitioners as they are much less expensive than a PCP and do more holistic approaches to weight loss.
Good luck to your Aunt!! you are a great niece.
Deb
245/235/169.5/150
Starting/Pre-op/Current/Goal
5'5.5" 6.6 cc in a 10 cc band
Starting/Pre-op/Current/Goal
5'5.5" 6.6 cc in a 10 cc band
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