Dr. Doesn't Believe in that Surgery!

Ok, I called the Surgical Office with my Managed Care Group and explained to her that my HMO just referred me back to them and said that the referral outside of them would have to come from the surgeon in my managed care group.

So here is what she said " I have read the notes here in your file and I will see if I can get the nurse to at least refer you out for second opinion. But the problem with RNY is that Dr. Horgan really wants the VSG for you because he just doesn't believe in the RNY. He is a skilled surgeon when it comes to doing the RNY, but he just doesn't believe in that surgery and the risks that comes along with it."

So I asked if I appealed with my insurance twice already and they saying no what do you want me to do? I am not going to pay out of my pocket for something that I don't have! I have 4 kids, a car note, mortgage, and everything else to go along with it so I am not going to self pay for that procedure. I would love to have it but the insurance said. NO NO NO!!

Then I called the new surgical team and the lady was really nice about it and said you know, your best bet is to continue fighting within your group because if you change your PCP it can possibly set you back even further. Plus she stated that UCSD has some of the best Dr. What the hell am I to do now? Somebody please help.

Can I force the surgeon to do the surgery I want?  What is my next step when it's going to come back to my managed health group?

Oh I forgot to mention that I called the DMHC to check the status of my IMR for the VSG, and she was kind of rude as hell but said that she "didn't you receive my letter? Well we have until 8/15/09 to give you an answer." I wanted so bad to call her a ***** but I didn't. Anyways she said if there is anything else you want us to have then send it. Well I can't get a ******g second opinion for so many reasons...the madness, when will it stop!!

Take the vsg,way less hassle,is the gold standard, everything still works and you will need way fewer meds and pills later. Check this out
http://www.ssat.com/video/2008/SSAT%2049th%20Annual%20Meetin g(3)-Cirangle_files/titlebar.htm
Great info,no question.
TIM

Me trying to decide which type of surgery is not the issue. VSG is not covered and I am not going to keep fighting for something that is not covered and in the meantime my health is not getting better. I don't need any facts on the surgery because I had them all. But thanks anyways.

I think they pay the insurance people to take rude lessons.  You can appeal your insurance company's decision, but without a doctor requesting the surgery you want, they won't pay for it.  If you are set on a different surgery than they reccommend, your only chance is to get a new doctor.  I'd probably go with the VSG at this point.  It's better than nothing.  Good luck.  I'll pray for you.

If my insurance would approve the VSG I would take it but they are saying no, so you mean take the RNY it's better than nothing.

I'm confused...so the Dr. doesn't believe in which surgery? I myself am trying for the DS...if my insurance co. won't pay I will fight it but if they still won't pay i will take the RNY..eeven tho it's not what I want...I need to do something and I only have ubtil Jan. which is when my ins.expires for this year..I have a 5800.deductible so I am not forking out that much and end up doing it all over again with nothing.But I do want the DS.

Good Luck!         Kim

I met with the surgeon after being denied the VSG twice and I requested the RNY because I didn't want to do the IMR with the DHMC and get in a long drawn out insurance battle when the problem with my approval is the particular surgery I am requesting is not covered. At that moment he said I don't do RNY. I said when I requested the referral you stated you do Lap Band, RNY, and VSG so I set up the appointment, got the referrals, and then submitted for VSG under the impression that if it was not approved we would proceed with RNY and now you are telling me 3 months in that you "don't do RNY?" Then he says well I don't do them on people like you. I said what? he says I save them for the really sick. So to sum it up he said it's either lap band or nothing. So I said I will change groups because you didn't even discuss this with me nor look at the term effects. He was a real asshole to be honest! I am in the process of changing Managed care groups so that I can use the center of exellence here! If that surgeon wants me to have the VSG then he can do it for free other than that I am not paying out of my pocket for this surgery when one that I will except is covered!

I am absolutely dumbfounded at the ignorance of that surgeon.,.,.RUN RUN RUN away...DO NOT LET HIM DO ANYTHING TO YOU  OR TO YOUR DOG FOR THAT MATTER....WTF is WRONG WITH HIM??

you need to switch gears...get your but to the center for excellence and say see you later to that doc...get your file and get a new doc.  HE IS NOT TO DICTATE TO YOU WHAT SURGERY TO HAVE...HE OUGHT TO BE ASHAMED...do they all have such god complexes...your body, your money, your life means YOUR descisions..

Good Luck and dont let ANYONE push you around

i have followed some of your story thus far and i agree with the above poster.Why do you want this Dr to do your surgery anyway? he seems to be a real ass **** . I would definitely run , if starting over is what it takes ,so be it . You have to trust your surgeon
 

WOW!What a jerk! I don't blame you! You go girl! Do what you have to do to get what you NEED! I hope all goes better for you from here on out! Take care!


Kim