More newbie questions

So, I have been completely obsessing over this dilemma. I know that my insurance requires a 6 month die****ch with my PCP before I even pursue them for the surgery. So I've been going over in my mind constantly how to go about this just perfectly so nothing gets messed up as to slow the process down any further.

So here's my questions --

Do I tell my PCP on the first appointment (don't have one yet so my new patient appointment will be the first meeting) that I want WLS and I need to have 6 months of die****ch for the insurance? Do I go once a month? Do I really have to follow the diet or is it all just red tape? Do I have to seek the psych eval on my own? I also need to be "diagnosed" with obesity for the last 5 years. I've never had a doctor tell me openly so how will I get the documentation? I've been over 200lbs for 10+ years.

So, I get the psych eval, 6 months weight loss watch, 5 year obesity diagnosis, and an out of pocket consultation with the surgeon and then I gather all this documentation and then what?

Thanks, I know it must be annoying but I think about nothing else these days and I just want to do it right, you know?

Welcome...

First thing I would do is to go to a WLS center in your area.  If you are in Nashville there are several, mostly at the big hospitals.

I had my surgery at Baptist, so I will only speak about the Baptist Metabolic Surgery Center.

Go in and talk with one of the Insurance persons.  At Baptist this consult is free and they take walk ins.  The insurance person will be able to get you all the information that you will need and what will be needed before they can submit for approval.

Sounds like you mostly know what is needed for your insurance.  Go to the insurance person and they will be able to answer all these questions and more.  Also go to support group meeting or seminar.

At Baptist they will recommend the Psyc doctor for you, and you will need to call his office to see if your insurance will cover it and what the co-pay, if any would be.  I was lucky, he took my insurance and my co-pay was only $15.

Please contact your local center as all insuance's are different.

I hope that this helps.

Michael

Luckily my insurance didn't require a 6 month diet. So i don't have the answers for you on that questiong.

But as for the diagnose of obesity. I had to have that for 5 years as well. And only last year did a doctor actually put on file that I was diagnosed with morbid obesity. But all the insurance requires is one record from any doctor for each year of how much you weighted. That there will prove enough to insurance that you were obese.

I also had my surgery at Baptist and they are awesome. The insurance lady helped me with everything I needed. So call or make a consult appt to get the ball rolling.

Good luck!

I went to a seminar for CMC and while they were very nice and helpful when I was directed to the insurance lady, after two emails, she only sent me a link to their website. I know it gets tedious answering all these questions but it's so frustrating and overwhelming with all these hoops to jump through. I was kinda put off by that.

My insurance is TennCare Amerigroup so of course people are less likely to help. Does Baptist accept it, would you know?

Thanks guys.

I don't know if Baptist does accept your insurance.

Call them up and that will be able to tell you over the phone.

I was told last night that Baptist has a little bit better insurance follow up with the people there than at other hosptials.  Now I'm not saying that any of the other hospitals are bad.

I have only had experience with Baptist and would always recommend them, so I'm partial.

One day during the week if you have some free time between the hours of 830a-330pm head over to Baptist and talk with them.  They should be able to get you in very quickly as long as it is not busy.

I was in and out in about an hour at the most.  I had all the information that I could ever want.  She explained what was needed by me and my Primary Doctor.  Another appointment was made to see the Surgen to discuss the types of surgeries and then we were each sent back to talk with the doctor, weigh in, etc.

Both of these visits were free BTW.

Hope that this helps.

Michael.

You wouldn't happen to have a link to their site would you?

Thanks!

Yes here is the link:
Baptist Metabolic Surgery Center

I hope that you can get your questions answered.

Michael.

What type of insurance do you have?

I have Tenn Care Amerigroup.

Here is a link to the TennCare insurance group. Call them and see whether they cover bariatric surgery, what their criteria is, and what hospitals they approve you to use. From there, schedule your appointments according and start jumping through the hoops.

http://www.amerigroupcorp.com/administrators/Pages/TN.aspx