Seething and Frustrated!

Hi, everyone.  Hope you've all had a good day and are having a good night.

I know this probably isn't a topic of too much interest for all you guys, but since I've posted here before, I figure I can at least get out some of my frustrations!  

I'm trying to move forward with surgery, but totally confused about which steps to take first.  I've been looking for surgeons in my area, and the list is very limited.  So today, I called my insurance company (Humana Gold Plus, a Medicare plan).  First of all, they've made it extremely difficulty to get a live human on the phone.  All I got at first were menus and explanations for things I already knew.  Finally got someone to talk to, who was really pretty rude and not helpful at all.  It was like I was speaking a foreign language to him, even though I know I was very clear and specific in what I asked, and that being an insurance company employee, he really should have understood what I wanted. 

Bottom line, I think I finally figured out that I have to see my pcp, and get a referral from him sent to a surgeon.  The thing is, the guy only gave me the name of a surgical group here in town, who doesn't do bariatric surgery! I did discover one bariatric group listed online for Humana providers, so guess that is the extent of my choice.  I'm hoping someone there has some experience and qualifications, considering I'm going to be putting my life in that person's hands!

The other thing I discovered by calling one surgeon's office (before I knew they wouldn't be an option for me), is that you can't attend one of their seminars unless they've received a referral from your pcp.  And with them, in order to speak with the surgeon to ask questions, you have to pay the surgical consult fee, or at least your co-pay if you have one for seeing a specialist.

I'm sorry for all the whining, and for how disjointed this post probably sounds.  I'm just frustrated at how difficult it is to really get any significant information!  I'm searching on OH, and online like crazy, and looking at doctor's websites, but it seems like you really need the info from the horse's mouth, so to speak, before you can make a firm decision about whether to jump through all the hoops!  The other thing is, I'm not getting any younger, and if I'm going to do this, I'd like to get it done ASAP, while I'm still alive to do it!

Anyone here have similar experiences?  If so, I'd sure love to hear any advice you have.  Thanks for listening, everyone! 

 

Where do you live?  If you are near Louisianna, Dr. Merriman takes medicare.   After the referral, his person will get you an appointment.  I had both medicare and a private insurance but at first, my private insurance did not want to pay.  Get you referral as quickly as you can and get started because medicare has a few extra hoops they make you jump through than the regular insurances like a year of supervised dieting--if you have ever been a member of tops or weigh****chers, and you have had a doctor talk to you about your weight, you can sort of make a connection between the two.  But do get the referral and see what you have to do.  I think I had to have a mental evaluation too and that included a test that my insurance or medicare didn't pay for  

Hi!

Different insurance companies have very different requirements, and many avoid giving you specific information, hoping you will get discouraged and desist.  Sad but true.

I went through years of trying before I found the people at Cleveland Clinic in Weston Florida, who new what my insurance prerequisites were and had a program designed to make sure I jumped through all the hoops.  It took a year of documented monthly nutritional counseling by a licensed nutritionist, a psychological evaluation, and medical clearances by all the doctors who were treating me for various conditions.   I could not have done it without the help and guidance of Cleveland Clinic's Bariatric Team.

Why don't you contact the bariatric group that accepts Humana and see if they have a similar program?  The may be able to guide you through the process.

Best of luck!

Our PCP knew exactly what Medicare required. He had a list of their guidelines and rules. Like 6 months of weight tracking. If my DH and the doc talked about anything else at that monthly visit it didn't count. And 6 months means once a month, not once every 30 days cause you could go the 1st and the 31st and one would not count! If anything like that happens, or you miss an appt. you have to start all over with your 6 months. Surgery had to be done at what Medicare considers a center of excellance. Medicare (and his med sup) paid for everything, including nutrition visit, psych eval, stress tests, everything! Of course, that was 2 years ago, so things might have changed.
Sounds like you may have an HMO? They may have different rules. Be persistant. Good luck!

Not sure where you live so it's hard to tell you where to go for a doctor or surgical group.I know when I started looking, my PCP recommended two groups, Barix and MMPC (now Grand Health Partners) in Michigan (I'm now in Indiana). I looked into both, but mostly MMPC because they were local.  They led me through the process. If it's a good bariatric group, they will do a lot of the heavy lifting for you.

You should look for a Center of Excellence ... I think that's what Medicare requires.

Good luck.

Your PCP should know where to send you also...and Eileen was right about going to a "CENTER FOR EXCELLENCE" because they are THE BEST!! All the rest that posted are also correct in what you need to do...Also I think you mentioned before that you were in Texas?

Good Luck and don't be a stranger because we are ALL here to help you through this!!!

HUGS

 I live in Indiana also.  The IU Med center bariatric dept. with about 6 surgeons hold open meetings for prospective patients.  You are not pressured to have the surgery but have the option of asking questions and talking to post op patients.  I felt very good about the Dr that presented the program and set up an appointment with him.  It is a Center for Excellence.  The staff did all the insurance work for me and notified me when I was approved.  It only took a week or two to hear back from them.  Their requirement is three classes with nutritionists for three months.  Medical tests are scheduled to insure you a safe and healthy outcome.  Once you have met the requirements they schedule a surgery date.  My date was delayed for a month due to the Dr's vacation that fell in August.  The surgery was done in a new IU facility with the latest hi tech equipment available.  The nurses and aides were fully educated on bariatric care and I felt totally safe under their care.
IU has a website with standard procedures and information. Google Indiana University Medical Center bariatrics.  
Additional note:  my PCP referral wasn't needed.