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Is your in/out of network coverage just a different copay split (30/70 vs 20/80) as is typical for a PPO, or no coverage vs. coverage? If it is just a different copay split, then there may not be a big of a difference as one may think, depending upon timing and cir****tances. Does your family normally use a lot of med care, and exceed, or comes close to, the max out of pocket levels of the policy?
When I had my WLS with Dr. Rabkin, he wasn't in network (he usually isn't, or wasn't at the time) but by the time Aetna paid off, we had met our max out of pocket expense for the year, so they paid his fee 100% even though he was out of network. Just a consideration. Also, some docs who are in network will charge a "program fee" to cover expenses not paid by the insurance - this is usually a nominal few hundred dollars, but can sometimes be thousands - so that is also something to work into your calculus.
Good luck in getting through this.
1st support group/seminar - 8/03 (has it been that long?)
Wife's DS - 5/05 w Dr. Robert Rabkin VSG on 5/9/11 by Dr. John Rabkin
Sounds like a good plan! If you need help with reading your labs, bring them here. Your Doctor will know a lot about reading your lab, the VETS here will know more.
HW: 398.8 SW:356 GW: 175 CW:147
Get a copy of your EOC (evidence of coverage), a lengthy document that details exactly what coverage you have or don't have. The people you contact by phone don't care whether or not they get it right, and especially with you needing a revision, there are often different criteria for that, so just knowing you are covered for "bariatric surgery" isn't sufficient.
If your insurance is through your employer or your husband's employer, you can get it through your or his HR. Just keep in mind that the first person you speak with in HR will probably have no idea what you're talking about, so you will need to go up the food chain. And the EOC isn't the little summary of benefits most people have, it should be about 100 pages.
Larra
Thank you.
I am waiting for doctor Ks response. My insurance website says Dr. K is not in network but then my insurance app says he is in network.
My husbands employee website says Bariatrics are excluded. I called the insurance company and they say there is no exclusion for the employees of that company. I also called the employee benefits line and they also said there is no exclusion.
So, I'm getting a bunch of different answers about everything.
I will look up Dr. R next and see what I find on him.
Thank you for your support. :)
I'm sorry that didn't work out for you. It sounded so good, too.
I would again recommend you contact Dr. John Rabkin in San Francisco and/or Dr. Ara Keshishian in Pasadena, CA. I have not heard of them rejecting anyone just because they had prior surgery in Mexico or another foreign country.
Larra
His office said he is no longer doing those surgeries because he is retiring. He won't even see me because my original surgery was done in Mexico.
I found out my insurance covers Bariatric Surgery and I found a vetted doctor in Network.
The doctor is retiring and doesn't do RNY to DS anymore. The new doctor doing it in that office is reluctant to take an RNY patient who had surgery in Mexico.
I have contacted several doctors who won't even see me because my surgery was done in Mexico.
Has anybody found an RNY to DS surgeon who took them on as a patient even though they had their original surgery in Mexico?
My first year I was taking all in one pills and they worked out fine for me then. My levels were always good, however I had to take 8 of them since they weren't specifically made for DS patients - just bariatric in general. The "normal" dose was three a day, but like I said I was told to take 8.
These new ones are specifically made for DS patients, and are high in ADEK. I think I'm safe with them for now, but my anniversary appointment with the doctor will be some time in July, so that lab result will be able to tell me if these are working or not.
I was taking the separate pills as you've been saying - prior to me not taking them - and I made it through an entire pregnancy with no complications and a healthy baby. If these don't work out, then I will go back to that. I will say, when I told my doctor that I wanted to start taking individual pills for things, they obviously let me, but looked sort of surprised. Most of the patients at my doctor apparently use an all in one multi as their main vitamin source. That is what was recommended to me when I started, and most of the patients, myself included, do fine with them.
I have also tried the patches in the past and they do NOT work. So if anyone reading this is thinking about trying those, PLEASE DON'T. I was on them for a week and got sick with all kinds of side effects.
You're in luck. Dr. Simper does do RNY to DS revisions and has an excellent reputation. Some travel for you, but well worth the effort.
Larra
Update: I verified the surgery is covered by my insurance (there is no exclusion). I have found a doctor in my network. Unfortunately, the doctors in CA are not in the network. The one I found is Dr. Simper in UT but I can't find much information/reviews for his RNY-DS revision work.
