Question:
Please Help - Ins. Question

Please Help!!! I live in Texas and want the DS procedure done. No doctors in Texas do this procedure. My Insurance - United Healthcare Choice Plus - only covers morbid obesity if I use an in network doctor. But their are no in network doctors in Texas. Any ideas???    — Melissa T. (posted on September 25, 2001)

September 25, 2001
If you would consider having it done outside of Texas, I know my insurance covers a wide span area for PPO, not just within my state. I don't know how yours works, but maybe this would be another option. Good luck!
   — Tisha G.

September 25, 2001
Are you sure? I live in Houston, and I can't imagine no one doing that surgery. But if it's true and you really want WLS maybe you would consider another type RNY? Good Luck
   — Cindee A.

September 25, 2001
Check with your insurance about an "inadequate coverage" clause. With my insurance, (Aetna), if there is no Doctor in my network for a certain procedure...they have to let me see a Dr of my choice in my area due to the fact that they have not provided adequate coverage in that field. Hope this helps.
   — skymaxjr

September 26, 2001
melissa, where do you live in Texas? I live in Austin... in Temple (about 1 hour away) there is Dr. Symmonds (Scot and White Hospital) and there is one (2 hours away) in San Antonio I believe his name is Dr. Pritcher? Good Luck!
   — rinkadinktx

September 26, 2001
I know how you feel... I'm in Florida and I want the DS. I am getting my papers ready to send to Dr. Rabkim's office because he's who I want to do the procedure. I have Cigna International so I have a good selection of doctors in the world, but Rabkim is unfortunately not one of them. All I can do is have the doctor submit a request and see if insurance approves it... and if they say no, I'll argue until I get my way ;) Good luck to you :)
   — [Anonymous]

September 26, 2001
The doctor I chose to do my surgery (10/17/01) is out of network. So at first my insurance company said that they would cover at 50%. I called my insurance company with another type of question and a very kind lady there told me that she was concerned for the out of pocket expense to me. I explained to her that there was no in network doctors who did this surgery. She had me go to the provider web site, print out the surgeons in a 20 mile radius from my zip code, call these doctors and note if they covered this or not. Well none of them did. I faxed the list with a letter of explaination. I got a call two days later to say that the out of network was overturned to in network. If you are willing to come to California, I would like to recommend Dr. Keshishian in Delano, Ca. 616-725-4847. He does not require a lump sum of money down before your surgery. His program fee is $2000 vs Rabkins $3000. Good Luck.
   — Jackie E.