mufasas-mom

Ok - little background. Last year i had knee surgery and the dr. at the hospital said I have pre-diabetes..they tested me several more times while i was at the hospital but nothing further was mentioned - so I assumed that my blood sugar level had spiked then went back to normal. Fast forward 1 year later - was hospitalized with pnumonia, for 5 days and on short term disability for 5 weeks going through breathing treatments - feel terrific now as this was about 2 months ago. Then this morning - I get a call from my Carewise nurse following up from my recent hospital stay and such and asked how I was doing with my diabetes.....I was like - um....I don't have diabetes as far as I know of - told her about the prior year when dr. mentioned pre-diabetic then nothing since then. Apparently my blood sugar was elevated while i was in the hospital and nobody noticed it - although I was being seen by a pulmonary dr, maybe he didn't notice it or didn't look at those results....Had the insurance nurse not looked at my records.....well who knows. So i promptly phoned my doctor and asked about it - they requested the testing results from the hospital and Lo and behold....they were elevated. Going in tomorrow for all sorts of blood work to find out what's up....THANK GOODNESS I've started this journey w/lapband and hope to be banded by August 2012 - so I can get rid of this excess weight.... Thank goodness for insurance....although I complain about it - I'm so thankful I have it. wonder if I do have diabetes (which I hope i DO NOT) if that would get my surgery pushed up a couple of months? I'm in month 4 of my 6 month wait-a-thon.

went to the doctors office this morning and they drew 3 vials of blood - they said they would get the results by Friday. I'm ok with that. I have one of the one touch meters at home when my boss bought me one when i got the 'pre-diabetes' chat last year. I tried using it last night - but it kept giving me errors. oh well....just have to wait and see. Least my dr office has an online lab results website where i can log in and check for my results. I'm sure all will be fine....was just a little disturbing getting a call like that from my insurance nurse

i'm sure i was on some type of steroids during my treatment - although they only took blood from me the day I arrived at the hospital - after that I had one more blood test the next morning. however, the year prior when i was in the hospital and had knee surgery that's when the doctor told me i was pre-diabetic - I was not on any steriods and such, as i was admitted for chest pains and vision loss (which went away). But they never came back and told me that I needed to be seen on any basis for diabetes - so i thought i was fine.... oh well - guess we shall see tomorrow when i go in for these tests. how long will it take I wonder to get the results back on my bloodwork.....

I too was concerned about the weight before the surgery....but I phoned my insurance and spoke with the bariatric nurse and she confirmed that they only go by the initial weigh in. However, my last visit I added a handful of the weights so i'd be right on the edge....

thanks - that's one of the tests they are doing tomorrow morning - have to fast tonight after midnight....no coffee in the morning so i feel sorry for those nurses - I'm gonna be quite the grumpy old lady....

FUNNY about the ankle weights - as i didn't weigh enough - needed to weigh 12 more pounds to reach BMI of 40 - so I took the ankle weights apart (the ones i got at WalMart had little separate weights in them) and put them in my socks (high up so they didn't slip down), pockets (wore large shirt over my pants so they couldn't tell) and added a few to my bra on the sides. I came in at 201pds and 41.1 BMI - so then I was worried that I'd have to do that every time, but I checked with my insurance and they only use the INITIAL weigh in).. i'd say GO FOR IT

I'm going to request mine be done at Trophy Club or at another hospital - don't want to have the surgery there at the center in Richardson - would prefer to be in hospital setting just in case although i think the trophy club is pretty far away from me - I live in Princeton, TX (9 miles east of McKinney)

I hope they take care of this for you....in a timely manner. I'd be pissed - but more at the fact that I can't make them do their jobs. My opinion on TR Richardson is they only want my money.... Are you having your surgery done at the center in there in Richardson??

I go back to TR Richardson end of this month - and will definately have the conversation about having the surgery at a hospital, not their little surgery center. I live alone and want to ensure that I can have assistance as needed for the first 24-48 hrs. They keep pushing their surgery center - but I will have to just push back. It's my surgery. anyone else have any issues with TR Richardson? I sort of feel like they are pushing me through the process so they can just get paid...don't get me wrong the staff is nice and all - but I feel that they are ONLY in it for the money....

ok - just got off the phone with a UHC rep who looked up my info and I'm good to go... there are no copays with my plan (which i didn't think i had) unless it's for the emergency room visit of $100/visit. SO I don't have to pay a penny anymore.....goodness I can sleep well tonight! Now hurry up last 3 visits!!

I have no 'co pays' with my insurance - just the full amount if the deductible has not been met - then 20% afterwards. But I'm still freaking confused.... I think I'll just call UHC and speak to someone otherwise I'll just drive myself nuts.....sucks being a control freak

OK here is the note i got back from United Healthcare: My question is - it says I'm still required to pay any co-pays....so, if I'm reading this correctly - my out of pocket max may be $2500 - but I could still end up paying over $5000 (just an example) out of pocket for the year... this is so confusing to me....guess I'm a moron - but I don't get it. what the heck good is having a maximum on out of pocket if it's really NOT actually what you would pay in a given year?? So - I guess I still have to come up with the 20% of the surgery?? Need to look at cashing out he 401K I guess....ugh - was so excited now my little happy balloon is deflated. Date: 05/09/2012 From: UHC Subject: Re: Out of Pocket Max - reached (KMM1089820V82888L0KM) Message: Dear Diane, Thank you for contacting UnitedHealthcare! I received your request about your out-of-pocket maximum. Once you have reached your deductible and out-of-pocket maximum all covered health services will be paid at 100% of the eligible expenses. I am showing that you have satisfied your network deductible and out-of-pocket maximum. The deductible and out-of-pocket maximum run on a calendar year basis, so they will start over come January 1, 2013. As long as all covered health services are received by network providers they will be paid at 100% of the eligible expenses until December 31, 2012. Please be aware that you are still required to pay any necessary copays. Payment decisions are based on your plan document. They are also based on the patient’s coverage when the service was received and billed by the doctor or facility. Please do not hesitate to contact us again with any further questions. We are happy to help you. Thank you for using Secure Messaging. I hope you have a nice day and wish you the best of luck on this process! Sincerely, Mandi K., UnitedHealthcare

oh yea....GO ME.....yippee - this is awesome.... I also double checked online to make sure....so this means no copay for psych exam - bloodwork and such.... wowzers.

I'm using True Results in Richardson - so maybe he is just with the Hurst location now.

YIKES....glad my doctor didn't say i MUST quit...but I know it's always advised....Good luck to you and hope you pass the 'no smoke' test!!

just found out this week that Dr. Mardsen is not in the True Results family of physicians. I'll end up with Dr. Benavides and having surgery done there at their facility in Richardson - according to them - but i did mention to the nurse that i'd prefer to have the surgery done at a hospital since i live alone...they said they'd work with me - we shall see - i will be very adament about it. I just called them as I wanted "IN WRITING" the surgery/dr. fees estimate prior to surgery.... lady there told me that I've met my deductible already - and I've met $500 of my out of pocket maximum (which i knew was incorrect, but let it go) and so they say that I won't have to pay anything at time of surgery. I logged onto my insurance website to see what has or has not been met - and yes, I've met my $750 deductible and yes I've already met my $2500 out of pocket maximum - so i shouldn't really have to pay anything.....we shall see

i also have uhc - and it is up to the employer as to what is put into the policy -which is why everyone's is so different even though they all have UHC. My company (PepsiCo) requires the 6 month pre-supervised visits if you have BMI 40+, if you have BMI less than 40 you must have 2 co morbidities. So far my 4th visit is end of the month as well as psych evaluation. I think the 5th visit is the EKG and lung capacity test (testing out your oxygen levels they told me). My BMI was 41.1 - although it's dropped to 38.6 as of my last visit - the nurse said 'you know your insurance will require the BMI over 40" to which i corrected her - my insurance only goes by the INITIAL BMI which was 41.1, so it's not an issue. She sort of had me freaked out and worried - but i re-read my notes from my UHC Carewise nurse, and i was correct, BUT i called my Carewise UHC nurse just to double check...thank goodness my notes were correct. All ok. You have to contact your insurance company to make sure you have all the facts correctly so you ensure there are no surprises - ask about copay - ask dr for written estimate of surgery costs so you can make sure after you've done all you are to do with the 6 months diet, psych eval,, EKG, blood work - that you know what exactly to expect.

I've not been banded yet - but i went shopping for some really pretty smaller plates so that when i do get to eat, the plate won't look so darn empty. don't know if that will work or not yet....we shall see. hope to be banded in August 2012.

does most of your doctors give you a sheet of what to eat and not eat after the surgery? also curious as it if anyone here 'practiced' the smaller bites ahead of time so we'd be used to it by the time we get to eat solids again? I have psych eval next appt - the 2 more appts to go and hopefully will be banded in August!!

Hello - I am new here. I went online to True Results.com and filled out the online info including insurance (united healthcare) to have it pre-approved prior to going in for the seminar. Went to the seminar and made my first appt - on my first appointment they weighed me (201 - BMI 41.1 - Height 4'11") and said I was approved because i was over the 40BMI. So then i called my insurance company to discuss the requirements and if this is covered like True Results said (because True Results is the middle man for the surgeon and insurance companies - so I am sure they would continue having you come in for monthly appointments -filing and getting paid by your insurance - then prior to surgery...OOPS it's now not covered - no loss to them as they'd been getting paid all along - THIS IS MY BIGGEST FEAR). In speaking with my insurance company - they could not find the Surgery Center of Richardson on the plan...which means it would be Out of Network (I'd have to pay 50%) - this is not happening. Then True Results reps say that they take and file this as In Network...how can they do that if it is truly OUT OF NETWORK...I'm so concerned I'm beginning this process of 6 months and then to have it yanked away at the end. I know the surgeon is OK and is IN NETWORK - guess I'll just have to make them do it at the hospital where it's In Network and not at their surgery facility - either way - I'm sure they'll still get paid. I have an appointment with the insurance companies nurse advocate on Monday - so i'll let you know how that goes....but i've done everything like they say. has anyone worked with united healthcare here in Texas?? can someone answer as it if I'm understanding how True results works??? I just don't want ANY SURPRISES......except the weight loss of course....

WOW - can't tell you how much better I feel now...I was worried it was a type of a scam to get me to go through them - they get paid and WHOOPS...you are out of network you owe $25000 - but if this is what you experienced, then i think i can get over my anxiety about that. Was the $500 your deductible? I'll find everything out on my next visit on the 27th and get it all in writing ahead of time....thanks again.

each company decides what types of benefits to add to their policies....it's all depended upon where you work and what type of policies they added. I got lucky....I guess

OK....i guess since my insurance is covering most of it - maybe that's why - i have to do the 6 month LONG wait.....but appt two is around the corner and i'm sure it will be here soon enough. sorry your insurance company didn't cover more....

do you have insurance or is this self pay? maybe because i have insurance - we have hoops to jump through and that maybe why they have called me several times to make sure i've contacted the insurance company for their guidelines and such. the seminar i went to was on a saturday - thank goodness. have you been doing any pre-op diet on your own??? i'm sure all will be great for your surgery tomorrow - I wish you much success....keep me posted.

wow - your surgery is tomorrow and they have not prepped you? that doesn't sound right...i have only had my first nutrition appt with them (other than the initial seminar) and have already spoken with them several times. what surgeon are you using? and what facility?