I need help!!!!!

danijackson732 · December 12, 2005

Hello everyone,

First, I want to say all of you good luck and best wishes. I know my title seemed a little urgent but being an overweighter means that everything is urgent for us, huh?

My question to all of those that can help me is this. I live in the Brooklyn, NY area and was going to have the lap band procedure with the CORI center (Centers for Obesity related illnesses) but am now thinking that maybe I shouldn't because......well, this is my story:

I have been researching the lap band procedure for over a year in NJ (where I used to live) and wanted to have it but couldn't because I had AETNA POS and they wouldn't pay for it. I kinda had given up until I moved back home (NY) and went to a free seminar for CORI. Well, at the time, I had Medicaid and in NY, they're making you choose a provider for your medicaid. There's a listing of maybe 20-25 choices. Well, after the seminar and talking with the staff that works at CORI and the surgeon who has performed (reportedly) over 1000 weight loss surgeries (lap band and gastric bypass), I felt comfortable with the idea of possibly having the surgery. I mean, it had been a year and after the Atkins diet, I hadn't kept off a pound. I'm 30 years old and have been big all my life. My Mother is big, my Dad is big and throughout my lifetime, I've always been a healthy active person but as I get older, it's getting harder to do so. Not to mention that I get bigger over the years. Anyway.....back to my question.

After getting with the Staff there at CORI, they helped me pick a provider that would easily approve the surgery along with the referral from my Primary Physician (wish was a breeze) and everything was good. Part of getting the approval was seeing a Psychiatrist (one time for about 45 mins.), a nutritionist (one time) and having the blood work done to make sure you don't have H-Pylori, etc. Well, all of this has been done and now come to find out, the doctor who had the seminar is on family leave and the staff (reportedly) doesn't know when he's coming back ("it should be after the first of the year")because of this......the doctor who mainly does the lap band surgery, Dr. Schedknuct is overbooked with the other doctor's clients, etc. It's a mess. I have a hard time understanding the fact that the staff doesn't know exactly when the doctor's coming back and of course, I'm now very hurt and impatiently waiting because I have done all of what I was supposed to do and now can't even get an appointment to discuss a surgery date. The seminar was in September. Also, my patient care coordinator at CORI called me 3 days ago to tell me that there was a problem with the contract at Victory Memorial Hospital and the insurance that I chose (Affinity Medicaid) so now I have to change carriers because even though the doctor takes the insurance, the hospital where the surgery will be performed doesn't, now. It's all so crazy, now. I am so pissed off. To choose another insurance that Medicaid offers would have to coincide with CORI and my primary physician and it looks like I'm only left with HIP or GHI. I've read on this site that GHI says no and then you have to appeal. I don't want to drag this out any longer. I feel hopeless. HIP sucks because you have to go their doctors unless you're going to a specialist and I want desperately to keep my primary physician. What should I do? Does anyone know any other physicians locally that takes Affinity Medicaid that comes highly recommended?

Chris S. - L.I. · December 12, 2005

I can recommend my doctor but I'm not sure he takes your insurance, you would have to call his office and speak to Joanne. He name is Dr. Alan Geiss and his associate (who is a cutie! LOL) is Dr. Colin Powers. They have over 1,000 banded patients. They are located in North Shore Syosset Hospital and the number is 516-496-2752.

porclndoll · December 12, 2005

I have GHI....GHI HMO and I got an approval within 2 days of my surgeons office submitting the paper work. I dont know if GHI Med. would work the same, but as a company I have had NOOO problems with them what so ever! I would keep on with the same surgeons office. You have done soo much with them and they have all your pprwk. The surgeon that you orgnially started with may be having some family problems that he needs to attend to, and the staff just can't say....or hes laying on a white sand beach somewhere, and they DONT WANT TO SAY Either or....you need to be comfortable in your decision. But for my experience GHI was great to work with.

Good luck to you~~~

danijackson732 · December 12, 2005

Thanks guys, GHI HMO is an option.......Did you have that, Porclndoll?

I just heard that they make you go through the six month (consecutive) thing?

Do you live in NY? Thanks to you, too Chris.

Alexandra · December 12, 2005

Dani, you are SOOO lucky to have so many choices!! Don't worry. When surgery is supposed to happen, it will happen. A few months at this point won't matter a whit down the line, however frustrating it feels. Believe me, I know.

But you clearly have options, and you WILL find the one that works for you. Thank your lucky stars you have insurance that will cover, and providers close by, and that you don't have to fly to another country or drive all over the Midwest to get the care you want. You're blessed, and the rest will come.

danijackson732 · December 13, 2005

Thank You So Much For The Reminder! I Know It Could Be Worst.

I've Wanted This Surgery For 2 Years.....and My Last Insurance Wouldn't Cover It At All, I Was Actually Contemplating The Gastric Bypass, Which I Know Is Not For Me.

Thank You......

I Love This Site!

Sincerely,

Soon To Be A Bandster-dani.

porclndoll · December 13, 2005

Dani...I do live in NY....Orange County....I had my surgery done in Port Jervis NY...which is about an hour north of New York City. I haven't heard of any new requirements for the LapBand surgery.....But then again, things tend to change over some months. In my situation they were awesome to work with~ I too knew something needed to be done when my weight was approaching 280 lbs!!! I have a friend who had gastric bypass and she dropped a tremendous amount of weight, but she also got addicted to her pain killers and she wasn't healthy. Shes doing better now...but she had a rough road and I saw her down it, and I knew that wasn't what I wanted. It is an amazing surgery and thankfully alot of people benefitted from it, but it isn't something I would have chose for myself. This Lap Band of mine is the best thing I have ever done, aside from having my child. This is the best thing I did for MYSELF.

Keep on in your Quest if this is what you want...and like I said, you need to be comfortable with your decisions...in insurance and especially with your surgeon~ Your going to know him or her for quite some time