The Getting Started puzzle

I've been wandering for a couple of months now trying to figure out how to get started.  I've made a few mistakes which has slowed the process down.  Let me share:  I started with my endocrinologist who thought RYN would be an excellent option for me especially to "cure" my diabetes.  I then made an appt with my PCP who also agreed and then wrote a referral to a surgeon for me.  I then called the surgeon to make the appt.  The surgeon's office pushed back and said I needed to first call CMC and make an appt with the Obesity treatment center.  After several attempts, I connected with them and they promptly pushed back and said I needed first to call Ask-A-Nurse to fill out a questionnaire and make an appt with them to attend an "info session".  They also said that I would need to re-contact my PCP and redirect the referral to them at the Obesity treatment center along with a faxed copy of my medical records.  When I called Ask-A-Nurse, they told me that they would mail me the "packet" with the questionnaire.  I am to complete the questionnaire and bring it to the next available "info session" on 8/6/08.  Whew!  I am told that once I attend the "info session" that it'll take upwards of 6 months before I see the surgeon.  I must say that this process is extraordinarily long.  Is this a way for the insurance companies to discourage people from taking this course of action?

The process is different everywhere that you go.  I am a patient of Dr. Campbell's and it is a busy program.  I encourage you to hang in there.  There are many steps to a good program and this is a great one.  Once you attend the information session, hand in your paperwork and get all your records and referral to the Obesity treatment center, you will get appointments with the intake nurse, nutritionist and the medical doctor of the program..They will all help you get any additional testing underway and the necessary weight loss help if needed to prior to surgery.  You are required to loose a percentage of body weight prior to surgery.  Once all is done, then they get you an appointment with the surgeon, which can take some time but once you see her, its usually about 4-6 weeks for surgery. There are also pre-op support groups that you cand attend.  There is one this coming MOndy at CMC, they are usually in the Roy Audiotorium but stop at the front desk and check.  theyare from 6- about 7:30.  I also go to the pre-op support groups. If you have any questions, feel free to PM me. Nicole

Also -- when you go to the preop support meeting - try to talk with Jackie and see if she can get you into an earlier info session. I recall she did that with someone at the last preop support meeting.

Ann
Also going to the OTC - but still preop going thru all the steps

yes, she did do that at the last one

Hi there and welcome!    I want to respond to your last question as to whether the programs are so invilved so insurance can reduce their costs.  I think not.  Insurances set up criteria that must be met in order to be approved and those critieria vary but most follow a basic guideline of a certain BMI, and so on.  Reputable bariatric programs have developed these extensive pre-op requirements in order to make sure they are selecting out only appropriate candidates.  They do this because they know from the scientific record that long-term success and the avoidance of serious illness is dependent on patients making life-long lifestyle changes.  The programs are trying to assess one's compliance.  It is less likely that anyone will really take in the vastness of this decision if a surgery can be had in 2 week's time.  And there are so many skills that need to be learned and so on.  So, insurances are taking their cues from the NIH guidance and the programs often go several steps beyond in order that patients have the best chances for going into to this well-informed, prepared, and coming out successful.  Phew!  Nice to meet you - Treading

I don't think it has to do with insurance at all. (Don't get me wrong, I'm not a fan of insurance companies! LOL!) The program I am in didn't even contact the insurance company until I had met all of their requirements, and the only thing I needed for approval was a high enough BMI.

Treading makes a good point about why the programs make you jump through so many hoops. It's also probably an issue with marketing- because if the program chooses only the people who are more likely to be successful, then they can tout an 85% or whatever success rate. If a program did the surgery on everyone who walked through the door, many of those people wouldn't be succesful with their efforts (since they hadn't gone through the education process ahead of time.) The weight loss program as a whole would be considered less successful, which definitely wouldn't be a selling point for them.

And you make an excellent point as well.  Marketing is everywhere, just as you say.  Thanks - Treading

I just have one note of caution for you with regard to insurance.  I started the process at CMC and, early on, contacted my insurance company to see what their criteria was for coverage.  They told me that they only covered WLS performed at Centers of Excellence.  CMC was not a COE, so I had to re-start the procedure at Tufts Medical Center in Boston, which is a COE.  So you may want to check on that.  It would be sad to go through everything at CMC only to find out that they won't cover you because of the place you chose.  If you have to go to a COE, I can say that I absolutely love the program at Tufts and highly recommend it.  I'm sure CMC's program is really good too, but I don't know because I couldn't stay at that facility due to my insurance company's requirements. 

Good advice.  I'll call the insurance ****igna) and ask.  Thanks.

I dont know if you have Cigna.... I could not really tell with the stupid astrix things that come up. Word of caution with Cigna.  Their WLS is a rider.   meaning that if your employer does not buy into the rider--then there is pretty much zero chance of getting approval.   You need to call and see if WLS is specifically excluded under your policy.  My surgeon even insisted that I get a letter directly from cigna stating that WLS is NOT excluded under my plan because they have had such trouble with them. Also----if Cigna does cover you....you will need six monthly documented visits with your PCP.  You CAN NOT miss even ONE month or you have to start over.   Another mention because you are in the Manchester area.....  Dartmouth Hitchock has MONTHLY informational meetings.  You do have to pre-register for them.  They are the second friday of every month at 2pm in manchester.  There program is designed somewhat different than CMC's is.  It is much more patient driven I think----you get to meet NO ONE from the surgery center until every i is dotted an every t is crossed.  Meaning they hand you a folder telling you what you need to have into them....and every last test needs to be done, every documentation into them before they will schedule you with anyone.  That sounds like  I am being negative---I'm not.  It depends on the type of person you are.  I have done both programs (LONG STORY).... CMC holds your hand more.  YOu meet with them pretty much upfront and work with them to coordinate testing and meet with the nutritionist right away.  Very different approaches. Sorry so long winded! Michelle