:-( Is it really this hard?

Hi guys, I am new to this group and have been in pre-op for quite awhile and was wondering if any of you have had as much trouble as me in trying to have surgery? Here is my story: After a long time of careful consideration to have Gastric Bypass Surgery, I consulted with my cardiologist on which doctor to use. My cardiologist referred me to Dr. Oxley at Williamson Medical Center. I contacted Dr. Oxley's office and started the process (in November!). I was told all the stuff that I had to have done so my insurance would cover it. After completing what the insurance required at the beginning of January, I thought everything was turned into the insurance and I was off to have surgery pretty soon. I was wrong. After waiting about 3 weeks, I had not heard anything from the Doctor's office so I had my Mom (God love her heart she has helped me so much with this, after all I am a man.) send an email to the office to check and see how everything was going. Much to our dismay we get an email back saying that they are sorry but Dr. Oxley has decided to pursue other medical interest and sorry for the inconvenience this has caused. What??? HELLO!!!! Where is the warning???? I was thinking to myself: Why didn't someone call me? What am I suppose to do now??? Is that it??? Well my Mom (being the great woman that she is) lit a fire under some butts, and got some referrals that would take my file and continue the process to the insurance company. I was told I would not have to repeat anything. Now after I have decided on Centennial (Dr. Dyer), they say that the info was not enough and needed more things from my primary care physician! Oh and by the way! After getting all the info to Centennial from Dr. Oxley's office, I got 2 phone calls from them saying that I needed to feel out a packet of information for them, which I anxiously did. The other call was to ask how much I weighted now. Nothing mentioned of the additional information needed from the primary care physician. Ok after waiting 2 weeks more, I ask my Mom to called them today (I can't make personal calls from work) and the nurse at first couldn't fine my file. Then finds it and that's when she informs my Mom that I needed more info from my primary care physician. I have not received any calls or emails from them requesting more info. My theory is, if more info is needed from the PCP why didn't the people needing the information call the PCP and ask for it? Or better yet why didn't the Dr. Dyer's office call the nurse at (use to be Dr. Oxley's office) and ask for it? Now it is MARCH and I'm still waiting. I just want to have the surgery so I can feel better and get off the heart medicine that I have to take. Any thoughts?

Start calling them at least once a week to check the progress. Hopefully this will light a fire under them to get you processed and scheduled just to get you off their backs. Good luck. I know it's frustrating now but it will be worth it in the end.

Hi John. Welcome to the TN Board. I am sorry you are having such a hard time getting approval for the surgery. Unfortunately, this happens all too often. It is normally a long road to getting approved and a surgery date. Hang in there. it will happen. More recently, some people who already had a surgery date and were on Medicare had to get there date cancelled because of a new rule. So, things are bound to happen. Just know that when it is meant to happen, it will. One thing I have learned is the getting calls from surgeons office is almost obsolete. You have to call them. And call them often. You need to call Centennial and see exactly what they need and you handle it. Don't rely on the nurses to handle it. I agree that they should handle it themselves but that doesn't happen as you have found out. If they need something, they won't call your Dr and they won't call you. They are just too busy. Not all offices are like this but it seems to more common. I had the same problem with Vanderbilt. I learned to handle it myself. You call your PCP and have them fax the info to centennial and then call centennial to make sure they got it and see if they need anything else. Call centennial a couple of times a wee****il you confirm it has been submitted to your insurance company and then call your insurance company to make sure they got it and keep calling your insurance co regularly to see what the status is. I had to learn that the hard way myself. It takes a lot of work on your part to get it done. It is great that your mom is helping you. Maybe she can make the calls for you. I would say you just need to find out what is needed by centennial and you and your mom do it your self and continue to follow up. I am still trying to get approval and I started the process last March. I am having to do a 6 month Dr supervised diet. Depending on your insurance, you need to be prepared to hear that requirement as well. Most require you to do that and be weighed in monthly. Just so you are not blindsighted like I was. Keep us updated on your progress. Good luck! Misty

Hey John, I was just approved to have my surgery with Dr. Houston at Centennial. It was a long process. I started in June with a six month dr. supervised diet. I kept a detailed food journal and exercise log during this time. I went every month to my PCP to weigh in and for nutritional counseling - meaning the nurse practitioner looked at and made notes in my journal and log and advised me of certain things. A letter of medical necessity was written from that office. The letter of medical necessity, medical charts for those 6 months, food journal and exercise log were sent via my PCP to Centennial. My 6 month diet ended on January 5, 2006. Centennial didn't receive that stuff until January 30th. I had to constantly call my PCP's office to make sure everything was being handled properly. They were super nice so I didn't feel too bad about it lol. Anyways, I get an email from Centennial that same day saying that additional information was needed... meaning they needed 5 years worth of medical records that indicated my weight. So I had to scramble to get all that stuff. Given my personal situation, it was a bit frustrating (moved around a lot, saw various doctors most of which I couldn't remember their names). If I had known I would have needed all that stuff, I would have had it already. So, Centennial had everything they needed on February 6th. So I waited a week and a half. I hadn't heard anything from Centennial. So I emailed Lisa Ferrell, one of the insurance specialists, on February 15th to check the status of my application (She is super easy to reach through email). They hadn't looked at my file yet! One of the financial counselors had jury duty for the previous week and paperwork was backed up. So, that following Monday, the 20th, I received a call from one of the other financial counselors, Cheryl Renfro. She said that I was missing a year of medical records for 2004 and that because I didn't have it I may not get approved but she was going to send it to the insurance company anyways for approval. I waited about a week and called the insurance company on Feb. 27th, they had my paperwork and it was being sent to the reviewer. I called my insurance company a couple of times for the next week and a half and FINALLY on March 7th I found out I was approved! I had a consultation with Dr. Houston the next day and was scheduled for surgery on April 11th. Thats my story. It is pretty much up to you to make sure that Centennial has everything they need. If they need more information from you PCP, call there and ask that ALL of your medical records be faxed to Centennial. But once you get approved by your insurance company, the process sure takes off and surgery will be here before you know it. And let me tell you, I haven't been able to sleep since I found out I was approved. This whole process takes an extraordinary amount of patience. No wonder they say patience is a virtue! Good luck to you! If you have any more questions, feel free to ask! April

John, honey, all good things come to those who wait. Call them every week, find out what all is needed and get it done. This is not something that is going to happen over night. The weight didn't just come on over night. Find out what all is needed, call your insurance company and see what all they require. Have you had to do a 3-6 month Dr. Supervised diet? Most insurance companies require a 6 month. Ask the surgeon, your insurance company, and your PCP what else is needed. Then it should be a breeze after that to get approved and a date. I'm here if you need help, make phone calls for you, or if you just need to vent. Just ask. Always, Kathy