new to this and feeling a bit lost

Hello everyone, I have been pursuing bariatric surgery since January of this year through the ECU School of Medicine in Greenville, NC. No one is telling me anything. My insurance requires the usual psyc evals and nutrition education, which I've already completed. I've also had an upper GI series, a ton of bloodwork, a stress test, a sleep study. I go for an anesthesia consult on Monday, 5/22 and for an endoscopy on Tuesday, June 6. The thing is, I have no idea where I am in this process because the surgeon's office is so unhelpful. When I went for my initial visit, I felt like the surgeon was dismissive, like he'd heard it all before. Then, whenever I've called to ask questions, the people I speak with act as if I'm putting them out and that I should already know these things because I attended the orientation session. I am afraid to be more demanding...or even to call to reschedule appointments...because I don't want them to drop me from the program. I keep telling myself to just keep jumping through the hoops and I'll get through it and be glad when I come out of the experience, but I have to admit that the stress of it is really starting to get to me. How do I know when my paperwork should be submitted to my insurance company (BCBS)? How do I know if I'm approved? Do I just need to keep calling the insurance folks to pester them about the progress? I realize that compared to a lot of people out there, I am just at the beginning. But any advice or experience anyone can offer would be invaluable to me. I really appreciate your taking the time to read my post and respond. Take care! Lisa

The process can be overwhelming! I will say that if you are feeling unsupported by your surgeon and the staff, I would consider a change. You are considering too big of a life-changing event not to be COMPLETELY informed as well as at ease with the medical staff. Just my opinion... Good Luck! Joy -105 5 1/2 months out

BCBS can provide you with a list of their requirements. Basically what they need is weight history for 5 years, med recs showing any co-morbidities, nutritional eval, psych eval and letters of med nec and other tests your dr deems necessary (stress/sleep etc). As for the Drs office.... its hard on both ends. The drs have a lot to do dealing with the insurance company and their patients... Im sure most of us feel lost and scared during the whole process since it is unfamiliar. You shouldnt leave everything up to the dr... do everything you can to help out. I called and got all my medical records, I followed up to make sure they were sent, I followed up to make sure my surgeon received. I called the office to see if they got my psych eval, if they didnt *I* called the psychs office and asked when they would be sending etc. If you feel like the Dr has everything they need or are unsure of whats next just give them a call... its better than letting your file sit forever. You are your own best advocate! Approval process... once a decision is made the insurance company will fax your doctors office as well as mail you a letter. The drs office may call to tell you or you will find out when you open the mailbox. Its been my experience that within BCBS make a decision on anything the letter went out the same day and I received within a day or two. Pestering the poor people who answer the phone at the insurance company doesnt do much. Once your paperwork is submitted, give a few days and call the insurance company to make sure they received. For the initital review they can take 30 days. I called once a week only to see if a decision was made (the people who answer the phone cannot tell you how far along in the process it is or how much longer, just the standard 30 days). Hope this helps!

Hi Lisa, I had surgery at ECU April 12th, and for me it also seemed like a long drawn out process, you didn't say who your Dr was, but the one I had has just gone through some office changes as far as staff, so there is a huge differance. They will not submitt your package to Ins. untill everything is completed and every I is dotted and all T's are crossed. They will call you and let you know when this happens, and also when you're approved and set a surgery date for you, at least thats the way they did it for me. Then you'll call ECU the evening before surgery and they will tell you what time to be there the next day. Wishing you the Best of luck, if I can be of any help just let me know. Take care, Hugs to you. Perry W.

Lisa, I have also been going through ECU for my surgery, that is scheduled for Wed 5-24. I'm not sure which of the doctors you are seeing there, I can speak for Dr. Pender who I have been seeing, he is awesome, very nice, answered all my questions and gave my family plenty of opportunity to ask as well. It is a long process. I have been working on it since last August. My advice is to you is to find out exactly what your insurance company requires. Call them directly they should be able to give you that information. After you have muddled through all those appointments, make sure they have all your results in to ECU, keep a copy for yourself if you have to pick things up, make a copy and deliver them(as I did) to assure nothing gets lost and if it does, you have a back up. And like Perry said, they will not turn it in, till it is ALL complete and they feel like you have all the information they will need. After they send it into insurance, call the insurance company and check the status, if they have recieved it, if it is in review, if it is approved. I had to stay on top of mine, first they said they had never received it so we had to work through that to get it "found" then once they had told me it was approved, that they had faxed a copy to my doc, the office said they hadn't gotten it and I had to have them to fax it again, this time to me and them, they said they still didn't get it, so at that point I had a copy of it and I could fax it to them myself. It is a bit of a challenge to get through all the red tape and paperwork. I have some email addresses if you need them, for the insurance lady, Liz and for one of the Nurses, that I can forward to you if you want them. That was how I found it easiest to get answers. That way they could check on my paperwork at their convience instead of me calling and maybe catching them when they were really busy and didn't have time right then. Don't give up. Email me if you want me to send you those. I work in Radiology at PCMH, I can speak from experience and say with confidence, that all 3 of those Docs are good. 1 of them doesn't have much personality sometimes, but he knows what he is doing, and thats speaking from a professional stand point. From a personal standpoint I can only speak for Dr. Pender and say he was wonderful. Sorry this was so long, just had to share my experience and let you know I will help you anyway I can.! Good Luck! ROBIN

Hi Robin, Congratulations on your surgery. I know you must be very happy to finally be to this phase. I, too, am seeing Dr. Pender, and because you are the second person to tell me how much you like him, I can only imagine that I was having a bad day, he was having a bad day, or I misinterpreted his demeanor. I have not had any interaction with him since I first visited him in February, so I have nothing more to go on than my initial consultation with him. I think I am meeting him again on Monday...and I'll definitely be seeing him on June 6, so I am looking forward to seeing if I was indeed mistaken about my first impression. Finding out what the insurance company required was a challenge. At the orientation session, when I explained that I did not work for the state, and therefore did not have the "usual" BCBS coverage, the women holding the meeting told me that they couldn't offer me any advice and that I should call my insurance company and ask "Is bariatric surgery a covered benefit?" What a nightmare this turned out to be. It took me no less than 5 separate phone calls to finally find someone who could discuss the requirements with any kind of intelligence. And when I requested a printed copy of the protocol, the rep said that it could only be sent to my doctor. So, they faxed it to him and he made a copy for me. After calling the dept. of surgery twice on Friday, I finally learned that after June 6, I will have completed all of my pre-op appointments. The only thing they are needing is weight records from 2001 and 2002...which is another nightmare, since one of those doctors is in Durham (I am currently in Greenville) and the other is in Colorado, where I lived for 3 years. My CO doc sent records for 2003 and 2004, so I'm not sure why 2002 was missing, but that goes to what you said about staying on top of it. I will definitely take your advice and check in with the insurance folks to see how things are progressing. I tend to be a bit of a control freak, so I'm trying to let the system work and resist the urge to call one or the other of these folks every single day. ha! However, I would appreciate the contact information for Liz and the nurse you mentioned. I won't bother them for now, but it would be nice to have that information in my back pocket should the need arise. I am just so nervous about the whole thing. My mother died at 54 from complications from diabetes, and I can see myself on that slippery slope...and I don't want to end up like her. It's hard for me to reconcile that a lot of it is just out of my hands and there's nothing I can do about it. I need to practice my patience and keep the faith that all will turn out as I hope for. Thanks so much for all of your advice! Lisa