Nicie

RJ: Congratulations on your weight loss. I am sorry to hear about your er doctor's treatment of you. All I can say is if you ever have the misfortune of having him treat you again, I would just state, in a very calm manner (not easy when you are in pain), exactly what you are feeling about his treatment of you and ask him if he is intentionally being dismisssive to you. You don't have to like him, but he must give you the best care possible and it is reasonable to question that care. Too much of your energy has already been expended on this issue. I have been in similar situations with doctors and all I would do is recommend you never have him treat you again (if possible). You need to heal and this will block your recovery. If you were in enough pain to make you go to an emergency room, I would question if what you were told is accurate. You are in my prayers.

Sending good thoughts your way. Keep me posted please.

Did the doctor say what caused your complications? Has he/she done many sleeve surgeries? I am so sorry for your pain. You are experiencing what I fear most about this surgery. How long would you have the stint in?

Thank you. Those are wise words. When is your surgery?

TaylorJ7: Thank you for your response. And please tell your wife I am sending good thoughts her way for a very successful surgery. It takes a great deal of courage and trust to go forward with this journey. I am so happy for you! 11 days post-op and you feel wonderful. I want that for me too! May I ask you how the after surgery pain was? How long were you in the hospital? Your advice to stay busy and focused will be followed but it is so hard to think of anything else.

Yes, that does help. It is like looking into a mirror when I read your response. Your experieces are the same as my experiences. The reason I started this process IS because I wanted to have the rest of my life lived as a thin, healthy person. I am just so sad it has come to the need for this tool to get to that place.

I start my pre-op diet tomorrow. Sleeve surgery is 8/28. I am 63 and can not believe I am going to let someone remove 3/4 of my stomach and risk all the complications because I can not control my weight! I have lost 25 lbs in the last 6 months and wonder if I should just cancel the surgery and see what happens in the next 6 months. I am currently 225 and have all the obese related diseases. I am not frightened about the surgery, just everything that comes after. I think if I did not have to wait so long for the operation day, I would have gone ahead with it. I just want to run away and forget all of this.

Dear Ramyers8679: How was the surgery? How are you dong now? How long did your surgery take? Are you in much pain? I am so happy for you! I am so grateful for this resource. It is because of this site that I pursued my inpatient approval and that will save me thousands of dollars. I can't wait until I have the inpatient approval in hand.

Great News! I just couldn't let this outpatient approval go uncontested when others have had the surgery as inpatient and bcbs customer support told me it is covered based upon medical necessity and is not an out patient only surgery. So, I had a conference call with the director of bariatrics and the people at bcbs who process the requests from the doctors office. Got this straightened out and the surgery will be approved as in patient. If the surgery was not approved as inpatient, I was ready to file an appeal with the federal employee benefit plan or with whoever handles the appeals. I was asking for a formal denial so that I would then have appeal rights. Did not have to go that route and inpatient it is! I am so excited and can't wait until I get the new approval letter.

Dear NoDramaLlama: Thank you for responding. I am so happy for you and hope you keep us posted on your surgery progress. I called bcbs again today. Was told the approval was submitted as outpatient and will be paid based upon that submittal. May I ask how you were able to get this inpatient approval? Any idea what the dr did to establish the medical necessity for inpatient stay? My doctor also keeps you in the hospital for two nights and they said the surgery can only be approved as out patient surgery?? I am so confussed.

Hi Jersrose43. Thank you for checking on me. The bariatric director contacted me yesterday and the insurance issue remains the same. I am hoping all goes well and it will be documented as inpatient after the surgery is done. Then, as you said, the doctor and hospital converse. Today I got me surgery date - 8/28/14. I appreciate your responses.

Anyone out there who has had the sleeve surgery - do you remember how your pre-certification approval was submitted? I would love to get more opinions on this. And thank you Jersrose43 for your input. 20 years insurance vet! Impressive! You certainly add an interesting perspective on this issue. I hear what you are saying and appreciate the input. However, it is in conflict with what bc/bs told me. Please be patient with me. I do have high blood pressure, diabetes, history of blood cloths and am 63 years old. Wouldn't you think that is enough to get initial certification for inpatient status? I do not want to put myself in a position where I am at the mercy of the hospital administrator. Is there anyway to get the hospital to request pre-certification for inpatient approval now?

Thank you for your response. Question - If the doctor's office knows the surgery is for inpatient care, why not just get the approval for an inpatient stay from your insurance company in the first place? BC/BS told me that if the surgery approval is for outpatient, that is how it will be paid. If there are complications, then the hospital can request inpatient status starting after the surgery. If no complications and you are there for just observation, you are responsible for 15%. So why take the chance of paying so much more for the surgery than you have to when there would be no question if the original approval is for inpatient?

I have bc/bs federal. My paperwork was submitted as outpatient. When I found out about this, I called the dr's office and was told bc/bs will not approve sleeve surgery for inpatient???? The dr's office told me they submit the request as outpatient and then after the surgery is done, they request approval for two nights stay. I was told it will be just fine, don't worry. That just didn't sound right so I called bc/bs and was told they approve the procedure based on what the dr says is medically necessary. If the approval is stated as outpatient, you are responsible for 15%. If the dr requests two nights for observation after the surgery, you are still responsible for 15% of the entire cost. So, if the surgery costs $50,000, I would owe $7,500 instead of just $250! Has anyone ever had this problem with the dr's office saying this is an outpatient only surgery for bc/bs and that is how they must submit the request? Does anyone know if it takes more paperwork to submit the request as inpatient? I am now really concerned that since the dr's office submitted the request as outpatient and it was approved, bc/bs will deny the inpatient request, if the dr's office resubmits. I sent an email to the director of the bariatric center and am waiting for a reply.

I have bc/bs federal. My paperwork was submitted as outpatient. When I found out about this, I called the dr's office and was told the insurance will not approve sleeve surgery for inpatient???? So they submit the request as outpatient and then get approval for two nights stay. I told them that the difference between inpatient and outpatient is significant. I was told it will be just fine, don't worry. That just didn't sound right so I called bc/bs and was told they approve the procedure based on what the dr says is medically necessary. If the approval is stated as outpatient, you are responsible for 15%. If the dr requests two nights for observation, you are still responsible for 15% of the entire cost. Has anyone ever had this problem with billing? I believe what bc/bs is saying and think the dr's office just does the minimal paperwork to get the approval. I sent an email to the director of the bariatric center and am waiting for a reply.