HMO's

This is driving me crazy! Over two weeks ago I went to TrueResults in San Antonio, talked to a really nice lady and she cheerlead me in to believing this surg. could acturally help me. I felt like there was a light at the end of my struggle. I know my insurance wouldn't cover the surg so I applyed for financing, Got it!
But for some reason the now the Dr. office, not True results is waiting for referals from my PCP.
I have no idea why?  They aren't going to pay for it, I guess they were hoping the HMO will pay for the dr's visit and the psych eval.  Well I"m just about to give up hope. I already paid the dr. office $250 just for him to tell me he is going to send me to psych and that this is a serious surgary, not another weight loss trick.
Has anyone else had this sort of problem, should I just give up?

Ami

Most doctor's offices require a psyche evaluation and a nutrition class before they will do surgery, whether you are self-pay or not.

This is a SERIOUS lifetime commitment and you need to know what you are getting yourself in to.  The psyche evaluation is a simple screening to make sure you understand what you are committing to. 

The nutrition class is the most important because that is where you will learn how you must eat FOR THE REST OF YOUR LIFE.  This isn't surgery like fixing a broken bone - cut, heal and done.  It may LOOK like effortless magic to those who watch us shrink before their eyes, but it take a lot of hard work, can bring you a lot of pain sometimes, and long term you have to adjust your eating habits or you will start to gain it back over time.

Since you are self-pay, have you researched all the surgeries available to you?  My insurance would only cover RNY and Lapband so those are the 2 that I researched, but you have the DS and VSG available to you also.

Which surgery did they recommend you have or do you want?

i was self pay. I STILL had to have the psych eval, nutrition consult, referrals from PCP, GYN etc, and H pylori test.  and i had to write a letter to surgeon stating why i wanted WLS and listing all the diets i had tried in my life.  Its not the surgeon trying to cause you a 'problem'.. but WLS is a big deal and its a mental trip as well as physical one. So yes you need to do whatever your surgeon requires.
My insurance paid for the psych eval but not the nutritional consult.
Dont give up, just do what you are supposed to and things will work out.
Youre not any more special than any one else here.

Thanks for your replies ladies.

I know the psych eval and nutrition consult are very important and I have no problem with them I just didn't know if everyone had problems with thier insurance getting consults.  I know i'll be self pay so I just wish I could set up my appointments and do them.

I guess I'll just wait and see what happens and if nothing happens and I fall through the cracks of the HMO I'll just take it as a sign from God. Maybe I shouldn't have surg.

Thanks again

I think it is VERY COMMON to run into all kinds of obstacles with insurance companies when it comes to WLS because they resist paying for it.  I will finally get Methodist Hospital paid off this month for all the BS my insurance wouldn't cover and I am almost a year out.

You gotta decide HOW BAD DO YOU WANT THIS ????  Because HMO's and insurance companies and even doctor's offices do not make it EASY!  This is different than any other medical issue you will ever deal with - if you were having a gallbladder attack and need your gallbladder removed you would be scheduled for surgery - no questions asked.  Obesity still has the stigma of all you need is "more willpower".

For me, it was worth EVERY PENNY and ALL THE AGGRAVATION and I was not self-pay.  I have my life back and I am a "normal" size.  I never want to go back to my fat-suit prison and I couldn't do it on my own no matter how many diets I went on!

Good luck, whatever you decide to do!

Sarah