Initial Appointment Today

I had my initial appointment today with Dr. Minasian (Anyone else use him before?). He was suggested to me by the Hurley Bariatric Center.

The good news is that he is all for the surgery (because I believe he does get kick backs for referring patients, hence why the HBC referred me to him, JMHO though) He said he'd even help push things through and in all honesty I hadn't even asked if he'd be willing to he just said he would, when I told him my insurance runs out in about 5 weeks.

I mentioned how I had to have a 12month diet history and basically he told me that if I couldn't get my one doctor to sign off on it to not worry about it.

I have been seeing a holistic chiropractor for almost 2 years now non-stop for at least 2 times a month for every month. Plus she is a nutrionalist, but of course I never really went to her for nutritional help or advice, nor was I weighed, but she is nice and is close to the family. I'm just afraid of asking her and her saying no to it and then having that weirdness there for appointments, especially if I still get the surgery. She's plus-sized too (ironically) and when I mentioned to her this past Tuesday of the WLS plans she really didn't say anything to me about it, one way or the other.

So even still, soon I am heading over to the Bariatric center to pick up the paper work I need to fill out for Tuesday's appointment. HBC already referred me to the physch, for the eval and I called them and waiting to hear back from them. I also have to do a records release form for the last 4 years too.

My head is kind of spinning with everything right now and I am still processing everything. If the PCP doctor does help with the diet history end of things and I DO get pushed through I could very well have a surgery date soon. To me that is surreal! I actually do not believe this will even happen and I believe something will prevent me from being able to go through with the surgery. Whether it be, because of the insurance or what, because it all seems too good to be true, yk?!

I want to be safe and do this right, but I also don't want to delay this for 2 years while insurance and jobs get settled too.

My other mental gymnastics has been deciding on which surgery. I know it's a personal choice and all, but I am kind of afraid of making the wrong choice. I KNOW which surgery I WANT but the insurance doesn't cover it . . .yet. I really would love to have the VSG as it seems the most practical for me in many ways. (rhetorical question coming) So do I get the lap-band and hope it works for me, and if it doesn't FULLY work for me then hope that the science has caught up with the insurance to the point where the VSG will be covered if I need to have another more complicated surgery? Or do I just dive right in and to the RnY? Again I know it's a personal decision and one really only I can make, but it is a tough one with the situation I am in.

It's not that I am not ready to have this done either, but as many or al of you know, this isn't exactly a super simple decision to make either.

Ok I think I am done with my rambling and if you actually read this whole thing, THANKS. 

Hi Welcome, First I want to say good luck and I hope everything goes good for you today! I know there is a lot to think about, try not to get overwhelmed. I think that you and your Doc. should be able to come to a conclusion on the best WLS choice for you. I know I didn't have the type that I thougth I would before my Drs. Appt's. So hang in there and do your research and ask you Doc. lots of questions. Joan

Hi Sephia -

A couple of things....

Dr. M is a good doctor.  No, I don't believe he gets kickbacks.  Every bariatric center has a regular MD they work with, and Dr. M happens to be Hurley's.  Of course he'll get his payment as usual from your insurance.  He spoke at our support group meeting the other night -- I'm currently not all that happy with him right now.  Read about my thoughts on his speech in my blog if you wish (link in siggy).

12-month diet history.  If your insurance company requires actual notations in  your medical chart -- there's NO getting around this.  What insurance do you have?  Have you called them already and gotten the exact list of criteria for surgery approval?  If not, do that TODAY -- have it mailed to you, have it in hand ... use that list as your checklist for getting everything approved.  Believe me when I say that having to start over from scratch to do the 12 month diet history for a second time really sucks.... be sure you have your ducks in a row according to what the insurance company wants/requires.  If you don't have that solidly in place, hold off on any other appointments until that's done.  Your psych eval is only good for 1 year... having to do it a second time sucks too.  (Speaking from experience)

I assume Hurley referred you to Dr. Williams for your psych.  He's good.  And he's super fast!  But his office staff is not the greatest ... so if you don't get a call back, keep on them.  You might need to call a few times before you get their attention, but Dr. Williams is worth it.  Once you see him, your results will be done THAT day.  He faxes your approval letter to Hurley before 5pm on the day of your appointment.  He's been doing WLS psych evals for over 20 years... so he knows his stuff.

As to which surgery.  I would suggest buying the boook WLS For Dummies.  (I bought mine on Amazon.com)  It will outline every surgery, give you the pros and cons of each and help you decide which one is best for YOU based on your pre-op habits, expectations and lifestyle.  It'll also walk you through the whole process of getting surgery, which questions to ask and even give you general information about nutrition after surgery.  DO NOT rush this decision.  It's one you have to live with your whole life... so if you are not 200% sure of your decision, wait until you are.  An extra 3 or 4 weeks is not going to make that big of a deal in the grand scheme of things, right?  Be sure.

And just for reference sake... VSG has the lowest expected weight loss and has the highest rate of revision due to failure to lose enough weight.  Again... do your research and look at every angle of every surgery.  Here's a good website to get you started:  http://www.wlswiki.com/index.php?title=Main_Page

Holler if you ahve any more questions...
Pam

12-month diet history.  If your insurance company requires actual notations in  your medical chart -- there's NO getting around this.  What insurance do you have?  BCBS - Teamsters I covered that in the Diet History thread which you believe I put the wrong insurance link to a completely different state, and I did not. That link clearly states what I need and I have clearly pasted it there and even highlighted. Have you called them already and gotten the exact list of criteria for surgery approval?  I did that over almost 2 weeks ago. It was my catalyst for finally calling and setting up my first appointment. If not, do that TODAY -- have it mailed to you, have it in hand ... use that list as your checklist for getting everything approved.  Believe me when I say that having to start over from scratch to do the 12 month diet history for a second time really sucks.... I guess it would be if one had already been waiting for 6-12 months. But since I am only 2 weeks into this process and on average most people wait 6-12 months then I would not be too upset at this point if I had to wait or start over since I know my situation and it is not completely 100% reliable right now. be sure you have your ducks in a row according to what the insurance company wants/requires.  If you don't have that solidly in place, hold off on any other appointments until that's done.  Your psych eval is only good for 1 year... having to do it a second time sucks too.  (Speaking from experience)

I assume Hurley referred you to Dr. Williams for your psych.  He's good.  And he's super fast!  But his office staff is not the greatest ... I noticed that when I initially called and was met with a "What?" on the other end of the phone instead of a hello or who I was even speaking to or if I had even called a professional office of any kind! so if you don't get a call back, keep on them.  You might need to call a few times before you get their attention, but Dr. Williams is worth it.  Once you see him, your results will be done THAT day.  He faxes your approval letter to Hurley before 5pm on the day of your appointment.  He's been doing WLS psych evals for over 20 years... so he knows his stuff.

DO NOT rush this decision. I haven't. I've thought about this and researched this for 3-4 years now. I'm just now dealing with insurance and what my options are through them. It's one you have to live with your whole life... so if you are not 200% sure of your decision, wait until you are.  An extra 3 or 4 weeks is not going to make that big of a deal in the grand scheme of things, right?  An extra 3-4 weeks for me will mean I will have to wait up to and over a year or possibly more as the future is not a stable future for us with work or insurance just yet. But again if it comes down to me having to wait that long because of insurance and money, then I guess I will have to do just that; wait.

Pam-
I have siggys turned off.  Can you send me the link to your blog?
Thanks!

ETA: I found it, thanks anyway!

I visited the BCBS link you posted in your Diet History thread and it is for Medicare patients. Are you old enough for Medicare? I have a friend who has BCBS and Medicare and it is different from regular BCBS.  

In the same post you listed your insurance requirements with one being a documentation of your weight, diets plans you used and exercise plans you followed during the 12-month structured program. Other than your chiropractor falsifying her records, be prepared to start fresh with your new insurance company. Regardless of what the bariatric doctor told you, it's the insurance company that gives the final approval, not the doctor.  I agree with what Pam said about starting a 12-month diet history over again.  It happened to me and was very disheartening. 

If you feel that you and your family will be on Medicaid, go to michigan.gov and check out the requirements. They could be much different than your current insurance. The good news is that whichever insurance company is responsible for your 12-month program, the 12 months will be good for any other insurance company. My COBRA ran out in Feb 2008 the exact month my 12-month diet program ended.  My new insurance started in Mar 2008 and the 12-month dieting documentation was good. 

One more thing to consider is the post-op doctor visits and any possible hospitalization that may occur right after surgery. I don't know anything about VSG, but with RNY you visit the dr one week after surgery to have the drainage tube removed, and then again at one month out and at three months out. I don't know what the schedule is after that. With the Lap band you need to visit the doctor a few times to adjust the band at the right level for you.  Those visits can be quite costly without insurance.   

  

 

Pam were you in the back of the room at the meeting.  I was looking for you but didn't find you

I really liked Dr M.  I was listening from a different perspective though.  (Like everthing is new.)  He is the one I have to see for my admit appointment too.

I really don't see him getting any "kick backs"  I've yet to come across anybody in the practice pushing the surgery, just the opp.

Good luck with every going as is best for you,  I reallize how you are trying to fight the clock.  If I had to start all over, I would have approched this process differently.  Doc Williams tried to tell me.

p.s.  nither will work FOR you, you have to work THEM.

Yes, I was there in the back.  I'm the one who asked the question: "So are you saying we don't need to take calcium?"  

Now I wish I would have turned around to see who was asking.  That's what I get for trying not to be rude.

Thanks for the help guys.

I believe I will be scrapping the whole ordeal until the timing is better.  I obviously haven't picked a doctor that I believe is listening well or taking my complete health into account. For the 2½ hours I was in Dr. M's office all I was met with was posters, pamphlets, and even exam table freebies. I personally take that as a sign that a doctor is into "it" for the money and not for the patient. I WATCHED him write down in my chart that I had sleep apnea based on me saying I snore. I WATCHED him write down I have hypertension based on ONE BP reading and nothing else, because it was elevated despite my HISTORY of normal BP readings, even when I was in the hospital just 4 months ago it was normal. There is such a thing called white coat syndrome. I WATCHED him change the depression on my chart to "mild" depression even though I stated I have had suicidal thoughts. I seriously would not put it past this guy to create a 12mo diet history for me so I could get the surgery ASAP before the insurance runs out. That to me says they are in it for the money and not for the safety of the patient.

I did personally call my insurance carrier 3 times now because you all make me doubt what I've been told and wrote down several times over.

I don't want to falsify documents just to be pushed through for surgery, nor do I want to ask anyone to do such a thing. Eventhough by the sound of it Dr. M hinted at and suggested that that is what he'd do since he told me NOT to worry about it and that "we get this done before the insurance runs out. No need to make you wait." That is what he said.

It's NOT about waiting, it about doing things right and properly and I certainly do not feel like he is going to do that. He never even discussed the fact that I have had some chest pains recently and in the past. BTW Doctors do get kick backs and a % for referrals. It may not always be legal but it DOES happen and it was just my impression of the situation, and I don't claim to be right, but I don't believe you should claim that he isn't without proof either. It is your opinion.

I even asked about being able to use a different bariatric center and I was told I couldn't. If he was just a PCP then why can't I get a referral to the hospital and bariatric center I want?! That makes no sense! It'd still be in my network and covered!

Either way, I just don't see this working out anytime soon. We still can't afford the 1-2 months of COBRA and even then WLS probably isn't even covered so paying for COBRA would be pointless. I'm just going to have to give up and wait probably over a year before I can doanything about this and pray I can be strong enough to not gain another 50 pounds in the mean time.