How to get insurance to pay!!!!

Well, a couple weeks ago I got acid reflux in the middle of the night thanks to my good old hiatal hernia. I ended up with bronchitis from it and I was lamenting my illness on one of my message boards. A nurse who worked for a bariatric surgeon told me that I could get surgery for that at the same time as the bypass and insurance would have to pay for all but the bypass. Well, I contacted Dr. Mirande's office in Klamath Falls and they checked into it and said they CAN do it! Woohoo! Not only that but now there are 2 surgeons here in Medford and one in Ashland that are going to start doing WLS. What a dream! There is actually a possibility that I could get this done here - in the same town I live in. No traveling over icy roads - no getting in airplanes! I am so stoked over this I can't contain myself. I might get to do this here!

YEAH! I think we will see more MD's doing this surgery in Oregon as our insurance programs losen up about payments for WLS. Right now very few Oregon insurance plans cover the procedures so not a high demand throughout the state. There are currently several states looking at including WLS as a medical condition. I remember when pregnancy was not included in Oregon group policies and wasn't a covered service until the State legislature made it a law. Probably the same will happen down the road with WLS. I'm excited for you Dina! KW

Dina - I am SO happy for you!! Going out of the Country is SO stressful. Dr Aguirre is really worth what you go through getting there ... but if you can stay home and close to your support network it will be a huge blessing! If I were you I'd look for a surgeon with lots of experience though.. do you have a network you have to stay in? There is Dr. Flannigan in Eugene... he is a top notch surgeon.. he is just short on the bedside manners. There are also a few in Roseburg but I know nothing about them..

CJ - I checked out the Dr. in Roseburg and was told he isn't accepting new patients. I asked if he was backlogged and got some silence. Pretty much it sounds like he might be suspended or something of that matter. Who knows. Either way I got the distinct impression that the person I was talking to was trying to keep me from running away screaming, yet whatever it was, would have done so had she said it upfront. KWIM? As for Dr. Flanigan, he wouldn't have anything to do with me knowing what insurance I have. He doesn't accept self-pay, so that's out. Besides I didn't have a positive experience when I went up there to see Welker (who I guess is now retired). One of the doctors here in Medford who will be doing the surgeries is the doctor who took my gallbladder out. I waiver on this though - whether I should see an established surgeon in this area for this or see someone who has had vastly more experience in this particular surgery instead. I just can't help but feel that my comfort zone would be more at home than elsewhere. A lot of people are going to K Falls to see Dr. Mirande - I've heard good and bad. I have heard good and bad about almost everyone though, so it's hard to sort out. I'm going to contact the office of the surgeon who did my gallbladder and talk to them on Monday and see what they are planning. Apparently they are going to be "open for business" with this in January. Maybe I can have them do the same with the insurance. We'll see. Dina

Hi Dina, I am new on these boards. So much information! I just love it. I am looking in to having this surgery also. I live in Roseburg. I was told that the doc here had problems doing this surgery, hospital made him quit doing it, so I wouldn't even consider having this surgery here. I have heard wonderful things about Dr. Tersigni in Coos Bay. He does it lap or open. I have a consultation with him on Dec. 8th. I can let you know how it goes if you want. Beth

Yes Dr. Tresigni is WONDERFUL!! He is very compasionate and also very skilled.. a rare package.. My husbands Aunt had surgery at the Bay Area Hospital last August .. she passed away about a month and a half post-op due to numerous complications.. her inscision never healed .. she had numbness in the leg - they just kept telling her oh you are fine.. I think it was likely a lack of vitamin B.. which can cause irreversable damage..However this is the criteria she used to select her Dr.. she went with the one she could pronouce even after I suggested she see Dr Tresigni.. now when it is your time it is your time.. HOWEVER.. choosing a Dr is a very important thing..this is a very major surgery.. it is risking your life..I wouldn't put myself in anyones hands who was not experienced in the field. Your Dr must be a cut above... accept nothing less!

Dina, Hi from a fellow Medford resident. I had my lap RNY with Dr. Mirande July 2002 and I absolutely LOVE him. I liked him before my surgery, but I love him after losing 225 pounds. The only possible negative thing I could say about him is that his office staff is a bit over whelmed at times. They are very nice, but things don't run as smoothly there as I might like. Happy to chat with you about anything - good luck in what ever you choose to do. Carol C.

Wow Carol!! What an AMAZING loss.. Congratulations!! You are a WLS hero!!