Shot down

Good Luck!

first it sounds like your surgeon has no intention on giving you the ds, btw my bmi was in the 30's with my ds.  second it is BS that you can't get a ds since there are other options for you.  now listen ......very well.....that is not the way it works.....if the ds is not available to you in network....your insurance co has to let you go out of network and YOU PAY IN NETWORK COSTS.   it is not your fault that the medically necessary surgery you need is not available in network, and for someone to TRY to say you have to get RNY is essentially performing battery on you.  YOU have the right to pick what surgery you want not others....keep fighting, don't get a surgery you don't want.....

Good point. If they deny I will appeal....

I will not be getting a RNY. 

Cathy Wuis, Dr. Kemmeter's coordinator at St. Mary's Hospital saw this post and asked me to give you her number (She's not registered on OH)

Here was her response...Tonya - Can you please give her my office number 616-685-5235 and have her call me. I can help her get the process started tomorrow! (I'm not on OH). Thanks! We don't have a BMI rule!

Please give her a call...She is very helpful :)

Kathy's a great lady.  She stopped by my room at Saints the other day, even though I wasn't even there for a bariatric procedure, just to introduce herself and say hi.

Wow! Thanks!! I talked to Nettie today. Do you think I should still call Cathy? What is the difference in what they do?

I would definitely talk to Cathy Wuis.  Cathy is the bariatric coordinator at St. Mary's and can definitely help get you started & navigate thru things since you would be a long distance patient.  Nettie is his scheduler who usually handles the insurance stuff - submittal, approvals, ect...She knows how to deal with the insurance companies & get it done (she is good).  Once approved, she makes sure all pre-op stuff is complete & schedules surgery.

I hope that this helps!

Another shout out for Dr. Kemmeter.  He's a great surgeon and his office staff is great too.  I am three years out from my DS and just recently had my gall bladder removed by him.  Aside from his joking, which is funny - he truly cares about the person behind the surgery.

I had my DS at St. Mary's and that was an awesome experience too.

I'm wishing you all the best!

I started out with one surgeon and found out he was an assembly line surgeon with little experience so I switched to another surgeon. I had already gone through the approval process and was approved but when I switched to Stewart I had to start it all over again. The insurance company made my life hell for that switch and it took time but I was approved. All my tests transferred over. You can do this. It is better that you get yourself a better surgeon. If these ladies here say Dr Kemmeters is best for you I agree with them. 

It won't take long in the scheme of things. Take a breat and start again. You will be better off in the long run. 

Thanks for all of the encouragement!!!! I talked to Nettie at Dr Kemmeter's office today. She said that she would talk to Dr Kemmeter today and make him aware of my situation to see if he could take me. She said they may be able to take me as an out of state patient so that I can just make one pre-op trip. I also would not have to repeat the psych eval and all of the pre-op stuff.

I just need to wait to see what insurance says. She said the big issue will be the insurance. So... I sent everything over to my PCP. She said she will send to the insurance company tomorrow to request an out network referral. I guess all I can do now is wait. (Which is driving me crazy.) Once I get the approval I will send my records to their office. I am really excited now about going with Dr Kemmeter.

I called Lalor's office and asked for something in writing that says he wouldn't do the DS because my BMI is less than 50. They told me that they spoke with Dr Lalor and they could send his last progress note. It just says that we discussed it, that he didn't feel I was a good DS candidate and that he told me that (which is true-- he did) but it didn't say that he told me to think about it and let him know (which he did.) It says I chose RNY (which I was initially leaning towards after him trying to talk me out of the DS.). There is nothing about me calling 3 different people to make them aware that I thought about it and chose DS. There is nothing that says WHY I am not a candidate and nothing that says your BMI has to be over 50- so I'm not sure if I should send that on to insurance or not?

I'm feeling a lot more positive about this.

Thanks everyone for your input. It really helped!