Dr Sudan patients

(Filling my mouth with reese's pieces)  *stressing*

How long did you have to wait to hear from Dr Sudans peoples after your surgery clearance appt? Im already nervous that I wont be approved for DS but Im trying to get my mind right to go with an alternative. I just need someone to call my damn phone! 


Thank u for listening 


Previously posted

Call them! Dr. Yoo was my surgeon and they are all in he same clinc. I wuld either email them or call them. After I started doing that I had my surgery date quick.

Have you already gotten approval for your surgery through your insurance? If so, find out from your insurance what the window is that you have to have your surgery performed after the approval. I would then contact the program office and let them know that you have tried to contact them and have waited for a response without success, that you are trying again, but will be contacting patient relations if you don't get a response within 48 to 72 hours. You may not get the answer  you want, but I'll bet you'll get a response. If not, contact patient relations and let them know what you've done and what you would like to have happen. 

Wishing you all the best,

BornLeader I sent you a PM related to this matter. I applied online and it took about a month for someone to call. Dr. Sudan and Dr. Torquati have the same Admin. Assistant, her name is Meghann.  It seems like forever but I soon realized that things had already been sent to BCBSNC regarding my surgery. So, it took about a month and my initial consult is 04.18.11.  So, from application date to initial consult it was almost 2 months. The information on Duke's website states that surgery is usually scheduled about 2-3 months from initial consult. If you wish to have DS and are with BCBSNC, your BMI must be 50 or more. I am telling you that upfront because they state BMI of 50 or more for DS.  Having to appeal is not the end of the world.  Hang in there and remember anything worth having is worth working for and definitely worth waiting for...

You should call them to see if they have received all the results from your test. After you get clearance it should only take a few days to hear from Meghann.

In my case they did not file my insurance until after I went to the pre-op appt, in which I was denied for VSG. I am in the process of appealing. The appeal process is not really that hard, it's just slow. I have BCBSNC state health plan so they do pay for the DS with BMI under 50, but not the VSG.

 

State plan pays for DS for under 50... It has to be 50 and over!. VSG is investigational so they wont pay it but if you can get an approval. Please sent a copy of your appeal letter because they would be damn near a miracle!

I just called and left a message for Nurse Shelia

http://www.bcbsnc.com/assets/services/public/pdfs/medicalpol icy/surgery_for_morbid_obesity.pdf

Hopefully, this will explain my post earlier.  Page 5, III, D states the following:

D. Biliopancreatic bypass with or without duodenal switch may be considered on an individual consideration basis for patients with a BMI>50.

I hope many of us find that BCBSNC will revise this "Corporate Policy," until then it will involve an appeal if we desire DS with a BMI under 50.  I would like to hear from anybody with BCBSNC who has been approved for DS with a BMI under 50.  Any information would be a gift and a big help.  Thanks ahead of time and best wishes to all in the journey.

Bornleader, I presume I understood you correctly that you had applied but were waiting for a phone call to acknowledge the application/set up consult.

Actually I already had my intial consult and sugery clearance. Im basically waiting on my surgery date and than they will submit to BCBSNC for an approval or DENIAL(which I think im gonna get anyway) Dr Sudan did tell me he had patients under a 50 bmi that had BCBSNC that was approved. Dont know if that was BS or not . Heres to hoping for a miracle

Great to hear you are just waiting to hear about surgery.  It will come...  I can only imagine how it must feel to be that close.  I am sure it is frustrating to say the least.  Well, I hope you get your surgery date soon and BCBS approves your surgery.

Keep us posted!!!!

Dr. Sudan told me that I would get approved for the DS with the state health plan over the VSG. I knew that going in. I schedule my surgery for 1/25/11 back in December. I went for my preop on 01/10/11. They submitted to insurance on that day for the DS. Then I changed my mind and decided I wanted the sleeve. They have to resubmit the information for the sleeve. 

Had they submitted when i booked the surgery I could have been appealing up to my original surgery date, but they don't file until you come in for your pre-op visit for some reason.

I was denied, Dr. Sudan did a peer to peer for me. They told him that if I had BCBSNC and not the state health plan they would have been able to reverse my decision. She said BCBSNC is not allowed to over turn any decisions done by the state health plan. She told me to do my first appeal and that will get denied. She said on the second appeal they will allow it to be reviewed by and external bariatric MD and I should be approved that way. She also said if I could hold off for a couple months they may be changing the guidelines anyway and allow the VSG.

I am on my second appeal and they are going to review my case on 04/05/11. So I am still waiting.

Don't give up. If you really want the DS appeal for it, that's if you get denied. You just might get approved if you have the State Health Plan.  The appeal process has been quicker than I thought it would be. My first letter was sent on 02/28/11.

There is girl that had the State Health plan with BMI under 50 get approved. I will sent you her name when I find it.