So Confused...

Ok, so I have all my test done and all the referrals are in... finally got the nutritionist eval to the surgeon... and haven't heard a thing! Me, being my nosy self, call when I've not heard anything in weeks. Guess what I find out? They are waiting on a six month diet that I've never had to do! I was told my insurance required it. So call the insurance... guess what... they DON'T need a six month diet before surgery. I'm so confused!!!! Anyone have Medicaid go through this? My PCP made me see her for a year before she would refer me. I've been on Metformin to get the PCOS under control to lose some weight and never lost a pound! I go to the YMCA to swim and workout... still nothing. I've done everything the PCP and psychologist have wanted and ordered. My bipolar has been uncontrollable at this weight. I've waited so long and interviewed almost every surgeon in this state. I'm tired. I'm stressed. I'm disappointed. Why, if the surgon's office wanted this, was I never told during my appointments? We sat there and went through my chart to make sure everything was there and ready to submit. This is two months wasted... oh, don't forget the year with the PCP that for some unknown reasons can't count (according to the surgeon)! Sorry so long... I just needed to rant. Thanks.

Ok. First of all Dr. Lowe doesn't require a 6 month diet. I know he didn't with me. Secondly, you need to contact the surgeon's office again and ask why they haven't submitted the paperwork because you have contacted your insurance and they informed you that you do not need the 6 month diet for approval. I am sorry you are so frustrated but if Mel is handling your insurance for Dr. Lowe's office Call her and ask her why she is stating you need this 6 month diet and tell her exactly what your insurance company said. Good luck and I am sorry for all your frustration. Shannon

Carrie is handling it. She's the one I've talked to. I think what really sent me into orbit was they 'were waiting on the six month diet' and didn't even bother to call me! I was told I would hear something in about two weeks after I had to go back down to Charlotte to meet with the nutritionist. If I hadn't of called I would still be here in the dark. Just got me in the wrong mood, I guess. I just went and made an appointment with my PCP for Wed. so I could talk to her and see what needs to be done from there. Medicaid told me to find another surgeon! I was floored. I've been all over this state and I'm not going through it all again... call me lazy or unmotivated, but it's really that I'm just brain-fried by now! I already have approval from my insurance so I'm confused. Thanks for the advice and letting me whine.

Don't worry about whining. Carrie is just Dr. Lowe's Medical assistant/nurse. The person in the office who handled all the insurance paperwork for me was Mel. I would call back and ask "Is Dr. Lowe requireing I have the 6th month diet?" If she says yes I would ask for a reason why because I know he didn't require it for me. If she says Medicaid requires then tell her no way. I am sorry you are going through all of this. It doesn't much make sense to me. But I would call Dr. Lowe's office back right away and ask them exactly why they are waiting on that. Shannon

If you have approval already from your insurance call and ask for something in writing. This surgery is expensive and all these dr's are running businesses. It's my understanding that dr lowe isn't just a baratric surgery so you will be in the rungs of a regular surgeons office with other surgeries. Check out dr volienger if you are already approved, changing shouldn't be a problem. You must remember, this surgery isn't life saving as if it was open heart surgery, or a lung transplant, so if it happens now or next month you will still be ok. It's ok to vent and admit you've been through the ringer. Stay strong and focused.

Thanks. I've made an appt with my PCP to see what she says about the past year. All my paperwork from them had to be sent over because it 'wasn't written good enough' to suit the surgeon's office. I'm going to do a little research this weekend and see what I can find out from others that have Medicaid and check on another surgeon. It's saddens me, I really like Dr. Lowe. I am a little pressed for time on the surgery so I can get back to where I can work. I miss working and I'm fed up with swollen feet, back pain and no control over my weight thanks to being heavily medicated because of my depression about being heavy! (Plus, I really miss my lap and holding the kids!) I'm like a catch-22 from h#$%! lol I have an active 8 year old to chase and run to practice and games and all that mess. Boy, I'm whiny today. I'm sorry I'm not normally a mope. Just on a down cycle of bipolar and can't handle paperwork confusion well! Thanks

Hey there - Medicaid does actually require a 6 month supervised diet. I do the insurance for our office and handle Medcaid on a weekly basis. There have been patients who didn't want to do and wanted me to submit w/o it and they were denied. So I have stopped doing that and now if we have medicaid they have to do the diet w/ their PCP before I will submit. Sorry...so it's not your doc it is however your insurance. I have the policy at the office that I would more then happy to fax or mail just let me know. Not sure how long you have been at the process of getting the surgery so hopefully it want hold you up too long. Now if you have completed a diet w/ in the last year or so they will take that as long as it's for 6 months. Good Luck!!!!

Thanks! I've been supervised for a year by my PCP and that's why I am confused! Why is that year not good enough when Medicaid says it is? I would love any info on Medicaid you have. Just email me at [email protected] Thanks again!!!

That year should actually be fine. As long as the clinical notes say that you and your doc talked about a diet and what they had you doing. I have actually had docs right very good letters and they be approved. I will try to remember to email that to you by monday. Good Luck!!!! Keep fighting because you should have to do more if you have already done a year.