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Lost

makemyownluck

717 views

I found out this morning that I was approved for a referral to see a surgeon for weight loss surgery. I was able to celebrate this "first submission approval" for approximately 30 minutes.

 

I called the MD, made an appointment, and then the woman who scheduled my appointment called me back to advise that the surgeon does not do VSG surgery, he only does RNY and lap band.

 

So, I called my MD office and talked to the girl who does the referral submissions, and said, "Hey, the surgeon doesn't do the surgery I want to have done. What now?" She had no idea. She said a message had been left for the nurse (why? IDK!) to call me back to discuss it. She asked me what surgery I wanted to have done, and asked me to repeat it THREE TIMES before telling me she had never heard of it and they only do referrals for rny and the lap band.

 

After that unsuccessful call, I called my medical group (I have H.M.O.) and they said that my MD would have to submit a determination of benefits to see if this surgery would even be covered. Now, I know for a fact that BCBS covers VSG - their medical policy is available online AND I used to work for blue cross doing these exact approvals, the only difference being that I worked for PPO, not H.M.O. Absolutely NO ONE I'VE TALKED TO HAS EVEN HEARD OF VSG. They act like RNY and the lap band are the only options for weight loss surgery! Besides VSG, there's also the duodenal switch - I've worked in insurance for years and know about all these options. Why is it that no one else seems to have heard of anything else?!

 

The medical group also advised that once they verify that the surgery is covered, they would have to request out of network benefits to see a surgeon out of network that performs this surgery. What an absolute nightmare this is turning out to be.

 

I tried calling back to talk to the woman who does the referrals at my MD office and she won't take my call. It doesn't look like the nurse is planning to call me back either, since the office closes in about 6 minutes.

 

I've honestly been bawling about this for over an hour, I have a headache now. I feel completely devastated and lost.

 

The only option I can come up with at this point is to change my medical plan at work to PPO in January. I really don't WANT to have a ppo plan, tho. I'm so completely depressed.

 

This is NOT how I wanted my weekend to start.

 

I guess I'll go lay down and cry some more now. :*(

 

I really, really, really, really, really don't want rny. Is my alternative to just get that surgery instead?? Or a lap band (which I've always been totally against!)?

 

Defeated. Crushed. Inconsolable. Lost.

 

That's me.



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Sry you are feeling defeated, but there is hope i am a bcbs *** patient my surgery date is 10/29. There is always more than one way to skin a cat. You have to be proactive use the internet find doctors in your area that do the sleeve, hospital affilication etc. Then go back to your pcp with a name of the person you want the referral to go to. My pcp did not initially refer me my hip doc(who i see every 2 yrs) suggested a docs name. Work it that way. Dont give up keep fighting your current insurance you have does pay i received a copy of bcbs medical policy under type its called "Medical Necessity and Investigational/Experimental original policy date 4/14/70 revision date 4/1/11. Good luck

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Call your insurance and ask them to mail you a guideline for weight lost surgery. Also ask them for surgeons in your area that perform weight lost surgery. VSG is a new surgery in the USA and most doctors don't want to perform this surgery because there is no long term data on it. I have BCBS and they sent me a email, but I have BCBS PPO and I performed most of my pre testing through my husband's job-due to a no copayment and I will be admitted to that hospital for my surgery. I work at a doctor's office and deal with referrals and specialty request all day.

1. Call BCBS for weight lost surgeons and surgery guidelines

2. Call the surgeon ask if they perform VSG and accept your surgery

3. Call your PCP (primary care physician) and tell them you need a referral for the surgeon you chose.

If you have any further questions feel free to message me. It will all go smooth just demand what you want and do your research so they can't steer you in the wrong direction.

Good Luck Honey!

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thank you all --- I don't know what my Drs office did exactly, but they called me with a referral to a different surgeon. One that does VSG!! So, I'm back on track. I go to the seminar in 2 weeks and then schedule an appointment with the surgeon. I'm hoping the pre-op stuff I've done with my PCP will carry over to the surgeon so I won't have much to do after this.. fingers crossed!

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