What steps

Hey boarders! I need a bit of help ...I had my first consultation on Monday Aug 4th. Then I called back on Friday just to see if they (the dr's office) had mailed the letter to the insurance company. I was told that I would need a letter from my primary. I told the lady on the phone that my primary doesn't have to ok me seeing any specialist so, why would i need a letter from him and that Dr. Jawad's office should just send them the letter and ask for approval from the insurance company. I would like someone to tell me what steps should I take to move this process along and also what are the proper steps in getting the ball rolling on my surgery? thanx guys

Hi Bre, I don't have to have anything from my primary to see a specialist either. However, I did take a letter of medical neccesity from my PCP to the surgeons office stating that my primary felt that weight loss surgery would be a great help to me in improving my help. That my health problems were all due to being over weight. The more items of this type that they can send to the insurance company the better. Good luck!

In my opinion, you should follow the directions Dr. Jawad's office lays out. I just got approved and although my insurance did not require a referral to my surgeon, the surgeon's office had a very deliberate process, as a response the the insurance company's very deliberate and methodical approval process. It's easier to NOT buck the system on this. You probably don't know all the inner workings of insurance/surgeon's office dealings, and frequently they ask for really good documentation at the surgeon so they can save time later. Instead of calling you and having you run around collecting additional info and documentation, they can have it on hand and fax it immediately. I had all my ducks in a row and it still took 10 weeks between getting records and getting approval, and I have one of the easiest insurances around. Good Luck. I would try and get a picture of the entire process from Dr. Jawad's office and follow it like a checklist. You'll be a lot less frustrated that way.

Every doctor and every insurance have different requirements. Its really about what your insurance requires. I had a letter from each of my specialists (diabetes, liver, pcp, neuro-sugeon, ortho), a psych eval, 2 yrs of diet attempts and their outcomes, and latest bloodwork. I was approved by my insurance within 2 hours. Just go by whatever your surgeon needs since they are the ones who routinely submit the paperwork and know what each insurance requires. Linda in Jax

Hi Bre, I have to defend Dr. Jawad's office a little here. First off, what kind of surgery are you going for? Lap-Band or RNY? Second, from what I understand they got you in for an appointment relatively fast. Normally people have to wait for an initial consult with him 3-4 months. He is an excellent surgeon. People come from all over the country to see him. I am very sorry, you were not explained what you need. Did you get a package to be filled out? In it, there should have been information concerning paperwork the insurance requires. If you did not get that yet, I would call them and ask for it. This could be the root of the confusion. They normally send that out before your first consult. In it are several forms to be filled out for the Dr. and some things you will need for insurance. Dr. Jawad's business coordinator Sandra is a very kind lady, she will do whatever she can to get you approved, but Like the other people said already, there are certain things that are crucial for the insurance to have. It is a surgery the insurance does not like to pay and they usually try to deny it. Now there are some great insurances out there, which won't give you much trouble but again try to get as much supportive material together as possible, it will save you a headache in the long run. I don't know if you have been on the Message Board on this site. There are many men and women, who have been trying to get surgery for years. Because one reason or another it has not happened. Again, please don't get upset with me. I am still waiting on approval myself. I have one of the insurances that are easy, but because my BMI is 39.5, 3 pounds too light basically, it had to go to level 2 review. Good Luck with everything. Marion

Bre - I read through your message and the postings and felt as though you were taking some of the comments defensively by your replies. Not sure if this is caused from your frustration or what. I can tell you this that each insurance company requires different documents to be submitted for individual cases. The replies from the people online and my reply is our experience in dealing with our situation. Each person's medical issues or different and therefore causes each claim to be handled differently. First, I want to apologize in advance if you have taken my words or the words of others online in this forum as personal attacks. I know that this whole process is dealing with a very personal issue, which sometime is handled differently emotional by people. Please do not take our words as threats or threatening words. We are here to support you and try to assist in making this whole ordeal easier for you. It is hard to remember that these doctors have so many patients and even with my doctor's office - the staff is small and probably overworked. There may be times when they may forget to instruct a patient of certain things. I found the details of this website to be invaluable and I actually used this information as a template to form a timeline of things I needed to do prior to even having an appointment with my surgeon, Dr. Overcash. I started this journey in April and saw many doctors, even though a referral was not necessary to see a specialist. Even though that sounds good - when it comes time for the insurance company to pay - you want to have all your ducks in a row and as much ammunition as possible. I actually wrote letters to my asthma/allergist, primary physician, and gastrointestinal doctor. My primary started from square one and requested me to get everything checked from top to bottom prior to the surgery. I ended up going to see a ENT, which found I needed a sleep study, from there I saw the sleep specialist and had two sleep studies, from blood work we found that my liver enzymes were elevated and then I had an ultrasound on my liver and found that I had "fatty liver", my insurance required a psych evaluation, nutritionist, (I actually saw two - one prior to initial consult with surgeon and the one he required after my consult), diet/exercise history for 5 years, I had to write a letter explaining what medical problems I had and that I understood the risks of the surgery, a family member had to also turn in a letter, a letter of support and medically necessity from my PCP, etc. I had to collect my own records and up to the last minute I had to stay on top of the doctors for them to get their information in. The more things you have prior to submittal - the better you will be in getting approved quicker. If you need help - please feel free to contact me either by phone (407-971-2164) or email. I am scheduled for RNY on 8/19/03 with Dr. Wm. Todd Overcash in Ocala, FL. Who are you seeing?