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Topic: RE: Frustration!!
This journey is not easy on anyone. It takes patience, preparation, and fortitude. You are not alone and you are not the only one who has had to struggle. In the end only your insurance company can tell you what you will need to do to get what coverage exists. Whether or not a doctor is in network with a particular insurer is up to the doctor and/or hospital. They have to agree to take whatever the insurer pays and follow the insurers guidelines. It may be that AmeriChoice is forcing either rates or care policies that the doctors find to obtrusive to deal with. TennCare has some really obnoxious rules.
If you opt for out-of-network care you always have a couple of options. You could get a third party insurer or self pay. In the end, it is your body and its your responsibility to make sure you can pay for your surgery - not the surgeons. They offer services like insurance coordinators to try and make it easier, but not taking TennCare is their choice - just like your favorite store deciding which Credit Cards to accept.
Feel your frustration, have your cry, and then try to re-evaluate your options. You probably have more than it feels like right now. The results of this surgery are well worth ANY ammount of frustration.
If you opt for out-of-network care you always have a couple of options. You could get a third party insurer or self pay. In the end, it is your body and its your responsibility to make sure you can pay for your surgery - not the surgeons. They offer services like insurance coordinators to try and make it easier, but not taking TennCare is their choice - just like your favorite store deciding which Credit Cards to accept.
Feel your frustration, have your cry, and then try to re-evaluate your options. You probably have more than it feels like right now. The results of this surgery are well worth ANY ammount of frustration.
_____________________________________________________________________
160 lbs lost. Surgeons Goal Reached in 33 weeks. My Goal in 37 Weeks.
VSG: 11/2/2011; LBL+Thigh Lift+BL: 10/3/2012; Brach+Mastopexy: 7/22/2013
Topic: Tennessee Medicare Post-Ops: Input needed
I finally got a call back from the surgeon's office in response to my application for surgery. I called Medicare before I ever turned in the application to confirm the qualifications for surgery, and I was told that I needed to have a BMI of of 35 or greater, at least one of the comorbidities listed (diabetes, hypertension, etc.), at had to have the surgery at a COE. However, when the lady from the surgeon's office called me back, she said that it had to be refractory hypertension with attempted treatment by at least three different medications. I researched this, and I found that guideline to be true for Medicare surgery applicants in Texas (something to do with approvals going through something called Trailblazer), but I can't find that documented anywhere for Tennessee. So, Tennessee surgery post-ops, or approval receivers, what was your experience? Did these very specific requirements apply to you?
Topic: RE: MEDICAID AND MEDICARE SURGEONS LIST!
Just kidding, after going to the seminar and filling out all the paper work, I find out that Dr. Sahagian is NOT in network with Amerigroup. I was fed up so I called the insurance and requested a case manager. He gave me a few names but after calling them, they didn't take it either. It took a office girl at one of those doctors to tell me the name of Dr. Kent at Cumberland Bariatric Institute (Lebanon) who is in network and is accepting it (apparently they have to be both). I called the office immediately and told them my issues and they assured me that he DOES and has done at least two surgeries for patients with Amerigroup/Medicaid.
Bottom line, fight for it, call the insurance, request a case manager, and don't give up until you find a surgeon who accepts it. It is covered by Medicaid so do not give up!
This will be my 4th seminar with as many doctors!
Bottom line, fight for it, call the insurance, request a case manager, and don't give up until you find a surgeon who accepts it. It is covered by Medicaid so do not give up!
This will be my 4th seminar with as many doctors!
k9ophile
on 6/21/12 3:45 am
on 6/21/12 3:45 am
Topic: RE: Frustration!!
It does sound like you're very frustrated, yet I do have a few comments that might put things in perspective. AmeriChoice may pay for WLS surgery, but what they pay physicians may not be worth the doctor's time. Why should a doctor have to take a deeply discounted rate when he/she has expenses like everyone else. I don't like it when I have my hours (income) cut, yet my expenses remain the same.
As for everyone else having it so easy, it may just seem that way right now. I was initially denied because even though my employer covered WLS, they did not follow their own criteria. When I asked about coverage, I was told something quite different from what I was told when I actually tried to get approved. It was three years before I finally got approved. And I work for a hospital that says its employees are the most important part of their services. (Don't ask for decent health care for yourself, but smile when you take care of others.) I'm not the only one who has had to fight for their WLS. This site is full of people who wanted to give up, but kept at it until they got their surgery. People have been known to go out of state or the country to get their surgery.
Take a deep breath, regroup, and keep going for what you want.
As for everyone else having it so easy, it may just seem that way right now. I was initially denied because even though my employer covered WLS, they did not follow their own criteria. When I asked about coverage, I was told something quite different from what I was told when I actually tried to get approved. It was three years before I finally got approved. And I work for a hospital that says its employees are the most important part of their services. (Don't ask for decent health care for yourself, but smile when you take care of others.) I'm not the only one who has had to fight for their WLS. This site is full of people who wanted to give up, but kept at it until they got their surgery. People have been known to go out of state or the country to get their surgery.
Take a deep breath, regroup, and keep going for what you want.
"Our ultimate freedom is the right and power to decide how anybody or anything outside ourselves will affect us." Stephen Covey
Don't litter! Spay or neuter your pet
Topic: RE: MEDICAID AND MEDICARE SURGEONS LIST!
Nope, there are still none...I don't understand why you cover it if you can't find any surgeons to take the insurance. That's so stupid to me. Like I've been trying for almost 2 years with different companies and I've not found one insurance company that I've had that will pay for it. I'm so frustrated!!!
Topic: Frustration!!
I am about to seriously go POSTAL!! Why is that AmeriChoice (TennCare) offers to pay for gastric bypass surgery but you have NO surgeons in network that will take the insurance. I just don't understand the rationale of the decisions of some things. I've been going back and forth and back and forth between insurance company, doctor, surgeon, insurance company and no one seems to know ANYTHING ABOUT ANYTHING. I'm getting to the point where I don't even care if I have the surgery or not because if you can't coordinate who pays for what and when I don't think I need to have you cutting on my precious body. I just don't get it, I'm so frustrated that I'm at work in my cubical right now crying because this is so difficult. No one understands how hard this is because everyone else has had their journey be a walk in park. No one else has had to struggle. No one else has had to jump through hoops, no one else has had to drive hours and hours away from their home over and over again to be told months later that they no longer accept your insurance. I'm just at the end of my rope.....
Topic: RE: where did john husted, md go?
I did a little searching for you, and it looks like he is now at Crown Surgery Medical Group in Corona, CA. His bio is on their web site here. The phone number is 951.736.0696. I called it and the voice mail does include his name. If you're unable to get a response that way, then here is a link with helpful information on getting your medical records when your doctor's office has closed or moved. I agree with the previous poster, that calling the hospital is probably your best bet if contacting him directly falls through. I hope this helps!
k9ophile
on 6/7/12 7:16 am
on 6/7/12 7:16 am
Topic: RE: where did john husted, md go?
In addition to what I told you in a PM, the hospital where your procedure was performed may have the records. TN law requires that hospitals keep the records for 10 years after the last contact the patient had with the facility. If you didn't have it done in TN, you'll need to find out the retention law for the state in which you did have the surgery. (Only God and Husted know where all that man has been.) That's all I can think of. Good luck.
"Our ultimate freedom is the right and power to decide how anybody or anything outside ourselves will affect us." Stephen Covey
Don't litter! Spay or neuter your pet
Topic: RE: MEDICAID AND MEDICARE SURGEONS LIST!
Dr. Kirk Sahagain in Clarksville takes Amerigroup. He called me himself this morning! I go to the seminar in two weeks and hopefully move forward from there. YAY!
Topic: where did john husted, md go?
I had surgery back in march of 2002 with dr husted and ive gained weight back. Im wanting to have a revision (stomphyx) done but no local dr will even speak to me without my records from when i had the original surgery done. Dr Husted has moved many, many times and i have no idea where he is and i cant get my medical records. Does anyone know what i can possibley do from this point? Know of any doctors who would be willing to help me. Ive exhausted every possibility of finding dr husted and I think he is out of practice and doesnt want to be found and I will never be able to get those records. Please help me someone Im very, very desperate.
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