Dr. Jawad's Process

Would someone walk me through the process required at Dr. Jawad's group? For example, what are the steps he has you take to get to a point where surgery can be scheduled? What testing does he require? What things can I have done in Orlando so that I don't have to drive to Ocala? I really wanted to go to Dr. Kim's group, but he is considered out of network. They can submit a request to have him covered, but after talking with Amanda today, they will most likely send me to the closest surgeon in network and that would be Dr. Beltre. I guess I don't want to take a chance in going through everything and then being denied due to using an out of network surgeon. I have a new patient appointment with Dr. Jawad on 7/3. I will be seeing my PCP for visit 5 of my 6 month plan on 7/9. I have Cigna and I talked to them today about thier co-morbid requirements...I got IN WRITING that insulin resistance is considered a co-morbid. I am really hoping they will approve that. Ali

Ali,  You are ahead of the game having the diet so on the way!  You will need to do a Phy evaluation, Nut evaluation, blood work, Gaul Bladder ultra sound if you have one, pcp letter supporting your wants and needs, and your medical history.  I live here in Orlando and I have Cigna HMO.  I work for Disney.  I called my ins company and my employer has phy plan that supported my evauation and they gave me the referal for that.  The Nut evau I did over the phone with Jennifer she is in Ocala and works hand and hand with Dr. J's office.  My PCP took the request from Dr J's office and added the request that were requested with his (I have blood work done every 3mo).  Also my PCP gave me a script for the GB ultra sound and asked them to send report to both PCP and Dr J's office.  When you go to your appt on 07-03 they will give you a sample letter to give to your PCP to have him or her note their support in having the surgery and Dr. J's office will send for the report on your medical history!  My PCP also gave me a copy of the front of my chart where everytime I went to visit him with my vitials and I was told that was a big help due to it showed my weight every time I went to see him.  Sorry I have went on and on but it is alot of work and you seem to want to get it done fast so there you go!  If I have left any stone unturned or you have any additional question please let me know!

Thanks for the info.  I also have Cigna (Open Access).  I have heard that Dr. J uses a Dr. Marcil in Orlando for his psych.evals.?? I was thinking about making an appointment with him now. Should I do that? Does everyone need an gallbladder u/s? If so, I am going to ask my PCP to order me one when I have my appointment on 7/9. What is your employer's psych plan? My employer requires that I go through a Condition Care Management program with them. It focuses on the behavioral management of weight loss. They provide education, support, I think a psych. eval and a nutrition eval. She said that can take about 8 weeks.

Ali

 

HI Ali, I answered you on the other board about the psych appointment. You can use anyone you want or you can go with the ones that he uses, it's up to you. And yes you can get all of your tests done here in Orlando. Yes everyone needs the gallbladder ultrasound, everyone needs the psych, the nutrionist, you can use his if you want, she does phone consults so you don't have to drive up there for it, if you want to use your own you can and everyone needs the blood work. Some need to have sleep tests done if you think you might have sleep apnea. I didn't need to do that though. But the more things you can get done the faster the process goes. After all of my tests were done I had a surgery date within a week. My insurance company approved within the first 24 hours for my first operation and 48 for my revision. Hope this helps!! Jo Ann

Ali, I sent you an answer on the other posting of Eli as well.  The only thing that Dr J added to mine was a stress test for heart clearance because of my age.  That went fine and after all paperwork was submitted I was approved in one week and had my date the same day I was approved.  I have BCBS state employee so I cannot comment on your coverage,  but mine had an exclusion that Odalys told me about and we worked all of the things needed to get around the exclusion.   Sandy Wesley

Hi Ali,

Actually, what would happen is that Cigna would most likely send you to Dr. Beltre, if you are approved. *Unless* you call Cigna and alert them to the fact, even though Dr. Beltre is in network, he requires you to pay your surgeon's fee up front.

Did you get in writing that insulin resistence is a *significant* co-morbid condition, as is specified in the Cigna policy bulletin?

Amanda can still submit you, just let us know so that our office and Dr. J's office aren't both working your case.

HTH,

Kristen

The Cigna letter sts that "insulin resistance, a pre-diabetic state, would be considered a covered diagnosis, along with the coverage positions for bariatric surgery." I think it is just safer to complete everything with an in-network provider. I don't want to take the risk in getting stuck with the bill if I do not have to.  I would love to work with your office though. You all have been extremely helpful. Ali

If either or both of the letters on my profile helps you with approval, feel free to use them!  Good luck!