Feb 20 Seminar in Berwick, ME

Anyone attending?  I will be going to that one.  My primary doc whose office is in the same building as Dr. Pacuili (sp) at PRH gave me a referral to see her, but she won't until I go to the seminar.   So I am headed to that one to start the process.  Anyone else going? What should I expect?  What is the typical time between sending in your 'application' to an appt to see a doctor?  How long is the seminar? I *almost* went to the seminar in January at the Frank Jones center, but I wanted to talk to my primary about this first - I was under the impression you had to go to the session at some point, not first. Oh well. Jenn

Hi Jenn,     Pleased to meet you.  I was at the Jan session so I won't be there on the 20th.  Some post-ops from the PRH program could give you the entire line up but I can tell you you won't be seeing the surgeon for a while unless you are able to do this outisde of the program.  It goes something like this:  you submit app and then get a call from Nancy (RN) to set up intitial consult (with her), then you see the NUT and the Psych (5 xs) and the PT and meanwhile you have to get a referral from PCP and get any and all pre-op testing done (blood, chest xray, sleep study, and so on), oh, and you attend so many support meetings and you lose weight AND THEN and only then do you see the (a) surgeon, get insurance approval and set a surgery date.  I'm forgetting a few details but that's the gist of it.   I don't know how long it takes but I'd say it ranges a bit depending on how many of these appts you can handle.  I'm just starting and expect it all to take 7 months or more because I can't take gobs of time off and will have to space out my apts to lessen the impact on my workplace.  Course, that's how the program works but maybe your situation is diferent.  Welcome and best of luck - Treading

Treading, Thanks so much!  I expect it to be a process, unfortunately.  I read in another thread, you are a State Employee?  I am as well, so I was also curious about the new health insurance. I also read something about weighing in early to get a jump start on the 10% weight loss - what is that about and when can you do it?  I have a full blood workup my primary gave me to do as well as a referral from him, so at least I don't have to worry about that! I look forward to being part of this group. :) Jenn

Once again, Jenn, very pleased to meet you.    And nice to see another 'statey' on the forum!  I called our Anthem BCBS provider (using the 800 number on our cards) and asked to speak to some one in benefits.  I asked specifically what the policy was for coverage of WLS.  I was told we have coverage (after satisfying their criteria for medical necessity) for RNY and the lap band.  I was then directed on how to got to their medical policy on bariatric surgery using the websire (Anthem;s).  I was able to print the policy.  And I documented the call.  I gave that info to Nancy when I went to see her for my initial weigh in.    I decided to go to Derry and get an initial weight recorded even though I hadn't applied yet.  Nancy told us at the info meeting that we can go and be weighed anytime.  So, I did.  The seminar was an hour long.  VERY worth while, I thought.  It helps to understand that Nancy will use your application to verify that you have insurance coverage but coverage isn't the same as 'approval' for surgery.  Your personal approval depend on your case being determined to be 'medically necessary' AND your completing a set of pre-approval requirements.  Much of what the PRH program is about is documenting that necessity and your completion of the requirements.        Hope this helps.  I know it seems like a very long process but I'm finding there is so much to know, to research, to think about, and to prepare that I can't imagine rushing.  I feel I will need every minute of the months it will take to go through this program.  Maybe just me and I'm famously slow in making any decisions so..... Take care - Treading