Question:
Has anyone else had to basically do it all themselves?

I just started this process about a month ago and I am running into some things that no one else has seemed to have posted on in there profiles or in the Q&A.SO here goes. My PCM will not fill out my paperwork from the surgeon's office, but I do have a doc that will. HIs nurse told me to fill out all that I can and he will fill out the rest, I now find out that I have to find, make appointments with and see an endocrinologist, a nutrtionist and a psychiatrist. How do I know who is going to be knowledgable enough about my insurance requirements and what the surgeon's office wants if none of them are going to help me set all these things up? Has anyone else had to do this? I know my doc has no clue about this process he didn't even know that he could give me a referal out to the surgeon.I basically have to have all the stuff done that most get doen after there consult before I even know that the doc will do the surgery on me. I am a light weight my BMI is only 40.2 so I am scared that I am going to do all this and I could be denied by the surgeon and the insurance company for not meeting there limit.Any help or your experiance's with this are greatly appreciated.    — S C. (posted on December 11, 2002)

December 11, 2002
Hi there, S! I had to do a lot myself as well. I saw the surgeon and he gave me a list of the doctor's ( endo. psych) that he sends people to and I made the appointments. I called the insurance to make sure they were in network and that all the things the surgeon wanted done were covered. To be honest, I enjoyed doing it myself, it was very empowering to know I wasn't going to sit around and wait for the doctors to be ready, I made sure they knew I was ready. When the surgeon sent all my info to get approved, the very next day, I started calling the Med. Director's office to see if I was getting approved. I got approved in a few days! And I had my consult in July and surgery in Sept. So it does pay off to take the bull by the horns, so to speak! Vi open RNY 9/23/02 -79lbs.
   — Vi F.

December 11, 2002
When I had my surgery I had to go for preop testing. If I was you I would contact the doctor that will be doing your proceedure and ask them if they have anyone that they prefer. For example, my surgeon had a team of individuals that they recommend since they understand the operation and your specific needs. You could then find out if those qualifed doctors are on your insurance. I constantly called my insurance company to recieve status up dates on my approval process. I was approved the first time. It helps to remain presistent. As far as your BMI. All of theinformation which I recieved from the insurance and the government indicates that the AMA recommends this surgery as a weight loss tool for people that have a BMI of 35 + comorbity problems or anyone with a BMI of 40 and up. So I don't think that will be a limiting factor. Good Luck
   — L S.

December 11, 2002
HI, Yes I had to do all the foot work, I was given a list of the pre-op testing to be done, and my PCP and I set up the appointments, and I had to be the one to gather all the information and get it to my surgeon (Which is a 4 hour drive away too, so most of the information was faxed or mailed)in a timely manner. You see I have a HMO insurance which my surgeon took, but her office staff did not take my hand and lead me or do the work for me as they do for PPO insurance patients. It was my responsibility to do it, get it done, turn it in. I agree with the poster that stated it gave me(us) power and made us stay on top of the process, follow through and have this WLS for better health. I suggest that you take a deep breath,as it can be overwhelming, take one step at a time. I have a lot of respect for myself for doing this task too. Good Luck, YOU can do it. Debbie Open RNY 8-23-01
   — Deborah H.

December 11, 2002
I, too, had to do everything myself. I learned what tests were required from this site, as well as other websites, told my doctor what referals I needed, etc. He basically just signed referals where I told him to. I worked for months trying to get approved...test after test, appointment after appointment, some at facilities more than an hour from my home. In the end I was denied and ended up self-paying.
   — Samantha S.

December 11, 2002
I had to do it all myself too. My PCP said he would authorize a referral to the surgeon I found, but that he wouldn't be involved beyond that. I found the surgeon on this site and cross-referenced it with my insurance provider's list to make sure it would be covered. Found the endocrinologist and shrink through the insurance list and made my own appointments to those, then called my PCP and told his insurance person to get authorizations for them for such and such dates (they seem to do what you want if you do all the legwork). I ran around town getting copies of all my medical records, old sleep studies, etc. and faxed them to the surgeon myself. Even had to hand deliver some things when they said they never rec'd the fax. I wrote out my diet history and provided it to the PCP as rational for the surgeon referral. I wrote the letter to the insurance review committee calmly begging for approval. I spent 7 weeks calling both the insurance company and the surgeon's insurance coordinator who didn't seem to want to do her job and taking notes about every single call. I swear, I needed a secretary! But after 10 months of work, I got my surgery and my insurance paid 100% of it. I've lost 65 lbs. in 2 1/2 months. It was well worth it! Do the work if you have to. No one else cares about you as much as you do! :)
   — ediecat