New Here and needing to vent

I just wanted to say Hi to everyone. I am new to this board (Thanks Heather) and just beginning my WLS journey. I haven't even been to the first seminar yet. We moved here from Florida last year (after Ivan), and live in Aiken but will be moving to Graniteville the end of this month. I have Premier Health Systems Ins., and was wondering if anyone else on here did. I am a little frustrated or probably more confused because I went to my doctor in september, and he was wanting to run test. I asked him wasn't my weight the main cause of all the problems I am having, and he said it was the biggest factor, and that if I could lose the pounds that the problems would go away. So we talked about different things, and the subject of WLS came up. I told him that I have thought about it for a long time, and feel I am ready to go that route. So he has referring me to Riverside Surgical. I called my insurance, and of course they tell me that my policy is not covered for obesity. So I asked the rep what if it was medically necessary. The rep said it has to be medically necessary or insurance will not cover it. Well I called two other times because I figured if I talked to different ones, and they gave me the same answer then it would be true. So I did get the same answer from two other reps. Here is why I am frustrated, I thought I would need a referal from my PCP for insurance approval reasons. Insurance says that I have to get PCP to send in for approval, but what they require to approve surgery is only after I go to the first seminar at Riverside to start the process. Has anyone else had this problem? So I called my doctor's office and talked to a lady, and she said to go ahead and go to the seminar because they would let me know what I need to get done, and they can put all the paper work together, that way it is coming from one place instead of several different places. Anyways, I go to my first seminar on Nov. 7. Has anyone else been to Riverside Surgical, and if so what was your experience like with them? Needless to say, I am on the scared side of having the surgery because of the prep, and what is going to be done to the inside of my body, and because of the stories of after surgery but on the other hand, I can't see going on like I am know for the rest of my life, only to know that my life will only get worse. I do want to know about what others have gone through (good or bad) because I want to be informed, and not go at it blindly. Thanks for listening. Denise

Denise, I am going through Riverside Surgical. Dr. Strickland is WONDERFUL!!! He is very caring and compassionate. I did have to go to the seminar before my PCP would give me the referral to Riverside. But since then Riverside has taken care of almost everything. The only thing I have had to do was set up my appt for my psych eval. I used Stephanie Greene (one they recommend) and she was great too. She is really in tune with WLS community. Riverside Surgical and Lexington Medical are the best in my humble opinion. I could be a little biased...I work at the hospital. Let me know if you want to chat...email is: [email protected] --Kelly

Hey Kelly Thanks for the info. That makes me feel a little better knowing that I do need to go to the seminar first. One of the reps from insurance company e-mailed me the requirements for the WLS. As I looked at it somethings I wonder if it will be ok. The requirements are have to be 18 (well, I am way past that one) the cpt codes and fees (I don't know what those are but I figured that Riverside would be the one to have those) documented history of mo for last 3 years w/documentation of BMI & and comorbid conditions (I do have my medical records from Florida that do document, I just hope that is acceptable. Plus my doctor from Florida just sent me a letter stating that she felt I was a perfect candidate for surgery and that she had seen me for the past 3 1/2 years. I hope this will be acceptable.) documented history of failure to sustain weight loss with medically supervised dietary & conservative treatment for at least 6-12 months which must be within 1 year of proposed surgery. Have to see dietician 3x's/month and physician 1x/month & documentation of exercise program. (This is one of those that can only be started after going to seminar) documentation of failure must be provided by a physician who does not perform bariatric surgery (Well hopefully that letter I received from dr. in Florida will help) documentation that patient is an acceptable operative risk (I think this one can only be done after seminar) documentation that patient has been evaluated and cleared for surgery by a licensed mental health provider regarding willingness to comply with treatment (I think this one can only be done after seminar) documented strategy regarding followup for 2 years (again I think this can only be done after seminar) Anyways that is the requirements. I did finally get a hold of someone in the claims dept. who was very nice and helpful, and she recommended having one place to send in all the info that way it would be nice and neat. So I guess now it is just a matter of time. Denise

Denise, Welcome to the family! AfroQueen

Welcome to the board and welcome to SC! I say go ahead to the seminar and you will be much less confused! My office here in the upstate handled EVERYTHING! They know about most of the insurances and they will be able to help steer you in the right direction. Leisa

Denise, It is a great idea to go to the seminar and even their support meeting. I got denied by my insurance company, but irregardless, Dr. Strickland is wonderful. Even though am from the Charleston area, I was going to use him because I thought he was the best. Even Lexington Medical Center seemed to be right on the money with the care that they offered, better than most! good luck to you!! Lori

I used Dr Givens and Dr Strickland (they perform the surgery together) when they were still with another practice. They branched out on their own into Riverside Surgical soon after my surgery with them. Dr Givens is great.... and definitely go to the seminar. This is just the starting process for them. They require you to go to this before they'll schedule a consult. You can check out their website at scobsesity.com. Good luck!

Hi Denise Welcome. I am from the Charleston area. I started out going to Dr. Sabback in Charleston. I had all my tests done and then Trident Hospital stopped all their WLS. So then I had to start all over again. Well I ended up at Riverside Surgical. Dr. Strickland is awesome. Their office stafe is great. You get both Dr. Strickland and Dr. Givens doing your surgery. Lexington Medical Center is awesome also. I've had a few surgeries in New Jersey and I can honestly say that Lexington Medical Center is the best. I had surgery on 7/6/05 and am down 67 lbs. I hope this helps. Wendy Fowler

Welcome Denise. I think once you go to the seminar, you will feel better about the process, and that it will help in your ability to go through this process. My personal situation was that I got the referral from my PCP to see the WLS MD, but the WLS MD, wouldn't see me until i had the referral. But, i found it to be nice, b/c as soon as the seminar was over, I was able to say yes, i still want to see this surgeon, and i had an appt the next week. So, that is how i found that part helpful to already have done. And in regards to your surgeon, Dr. Strickland is great. I work for a surgeon, and although I couldn't get mine done by Strickland b/c he wasn't covered under my ins., my surgeon highly recommended Strickland, and he has a good reputation even in the medical community. I look forward to hearing about your journey.

WELCOME TO THE BOARD, MS DENISE. FROM THE LOOKS OF THE ANSWERS TO YOUR POST, YOU GOT GREAT INFO REGARDING YOUR INSURANCE SITUATION. THIS CAN BE A FRUSTRATING, HARD JOURNEY, SO GIVE YOURSELF A BREAK ... PUSH THE NEGATIVE EMOTIONS OUT OF YOUR LIFE & FOCUS ON EVERY POSITIVE STEP YOU TAKE TOWARDS YOUR HEALTHY, ACTIVE LIFE TO COME! THAT WAY YOU CAN USE YOUR ENERGIES WHEN YOU REALLY NEED THEM ... TO RECOUPERATE FROM THE ACTUAL WLS!!!!!!! &, THE ABSOLUTE BEST THING YOU CAN DO FOR YOURSELF IS STAY ON THESE OBESITYHELP MESSAGE BOARDS & FIND A GOOD SUPPORT GROUP IN YOUR AREA. THAT WILL KEEP YOU INFORMED & THERE WILL ALWAYS BE SOMEONE TO LIFT YOUR SPIRITS WHEN THE ROAD GETS ROUGH. &, YOU'LL FIND YOURSELF RETURNING THE KINDESS WHEN YOU GET SOME TIME & KNOWLEDGE UNDER YOUR BELT! WE'RE ALL HERE FOR YOU! GOD BLESS YOU DAWN & NICK