Im getting disappointed -guidance anyone???

Okay guys i am back with an update. As i told you guys, a few months ago  i began my journey in my quest for a revision from lap band to duodenal switch when i tried to reach out to the University of MN. suffice to say after my initial meeting  everything went down hill from there as the nurse who was in charge of my insurance and medical coordination called and told me  that Dr. Ikramuddin would not perform a duodenal switch on me because he felt i needed to have a sleeve after having an initial surgery of removing the band in six months. this decision was made without the Dr. seeing me, according to the nurse,all the Dr. saw was my medical records from three years ago. this frustrating condescension lead me to this site seeking out options in finding a new Dr. that would do my surgery. I was lead to find the Methodist physician clinic in Omaha. My initial intake and consult with Dr. Daniel  Cronk  Jr.of the Methodist Physician clinic  was pleasant and reassuring especially since he advised that he could perform the surgery. here comes the doozer....

Okay, when i arrived i quickly set out to begin to meet all  the dietary and insurance medical requirements. I even sent in all my medical records from the previous years that would allow for me to get my medical requirement met. Initially, when medical records were sent to the clinic, they would call me one to two week later telling they did not get it, and the address that they give me was  the one i used. I would often have to sent one document more than once as the office would misplace my paperwork. I would sometimes go to my local release of information while standing there call to clinic to confirm whether my records were received. this was alarming but not as alarming as i am about to say, initially the office sent in a preliminary request for approval to my insurance, my insurance company is quite competent, (BCBS of ND), of course in a week the  ins company sent out a letter listing the requirements that must be received before determination can be made. this letter was sent out in January 30th 2016. February 05, the clinic called me to advise me that the letter stated that i needed to be a blue distinction or the insurance will not cover, thus they could not proceed with my surgery. this error was another signal of the level on incompetence i am dealing with, what the clinic failed to do  was to read the letter properly. the letter clearly stated (as i did receive a copy) that the insurance recognizes clinics that are designated  center of excellence or have a designate blue distinction to be recognized. i called my insurance company, confirmed it, call the office  manager , requested her to read the letter, when she did she got an aha moment, apologized and promised to proceed with the process. on Feb 12th the insurance coordinator called to advise me that she has sent in all the requirements to the insurance company. Keep in mind, the letter required a response  within the next 45 days from the date of the letter or my claim would be denied.  A week later, i called my insurance company to get a status update on my claim process, the insurance company stated that they have not heard from the clinic since they sent the response on Jan 30th. I called the clinic , spoke with the insurance coordinator and she told me that she did sent in  a response, but promise to look into the matter and  give me a call back. she did not call me back. two days later i called  my insurance company, they advised me they still have not gotten a call, nor any response from the clinic. I called the clinic, and the ins coordinator did the same round about , and went back to giving me a run down about the initial letter that was sent prior to the insurance response on the 30th. I  was told once again that they will be calling right away, and would get in touch with me, again no response. I waited another week, called my insurance company, inquiring into what was  going on?? i was been given a run around, clinic telling me one story insurance telling me another. A very kind insurance rep promised to get to the bottom of it and asked me to wait on the line so she can call the clinic to determine what was the matter. a few minutes later, she came on the line and told me that the clinic apologized , and told her that they have been sending in the documents but to another fax number (to whom my records were sent to..i do not know ), but the rep advised me that she has provided the clinic with the proper fax number to which these documents should be sent. Now i have waited for a week and i called the insurance company, they told me that they have received some documents from the clinic, but they are awaiting additional documents from the clinic. I called the clinic to inquired into whether they might be needing additional information from me, however the ins coordinator told me she had three people ahead of me and she took down my number and promise to give me a call, till this evening no one has called me back.

 

I am very disappointed , i expected more professionalism out of this clinic, but from what i am seeing, i am getting a weaker resolve by the minute, i am not sure i can trust this clinic with my medical care and i am thinking about restarting my search all over again for a new surgeon? any thoughts??

if you have any issues with care, now is the time to leave, hanging in there will only compound further down the road.  I dont like that have the vsg only before the DS, that is a very very rare-and I mean rare,  situtation in the hands of a revision surgeon.  Depending on severity of  damage, post lap band, waiting to be VSG is advised, but not doing the intestinal bypass at the same time (unless you have chronic health issues and you cannot tolerate being under for a lenght of time etc) is just unacceptable.  Go find yourself a different doctor.

I have already left the clinic who advised me to get a VSG  first, now i am with a clinic that i constantly treating me like i am stupid, giving me the run around, not answering my questions when asked, not properly advocating on my behalf. I feel like i need to reach out a speak with the Dr. himself, cause i really liked him as a person. This treatment is unacceptable to me or anyone.

I'm sorry you are having such problems with the clinic staff, but hope you will differentiate between them vs the competence of the surgeon. Definitely he needs to be informed about his staff, but their failings have nothing to do with his abilities in the OR. Hang in there, call every day if you have to, til everything gets to the insurance company. It's a shame this is happening, but the bottom line is that your revision alternatives are limited, you have found a surgeon you like who is willing and able to do your DS and NOT insisting on a VSG first and then a long wait. The people you are having a problem with are not the ones who will be providing your medical care.

Larra

Thanks.. i will keep trying.

I had my surgery at that office, but not with Dr. Cronk. I believe the same person is still in charge of insurance and she is terrible to work with. Keep on top of it, keep calling and calling until you get what you need. The doctors and nurses there on the other hand are wonderful! When you have your surgery they always have two surgeons in the operating room. You will get Dr. Cronk and either Dr. Winterstein or Dr. Anthone assisting. You won't get this everywhere else.

That is a relief. It was just to horrifying!! but what you said have given be hope to keep on.