A Dreaded Delay Once Again

Dody · March 15, 2006

Well, needless to say I'm still in a state of shock. I've had all my tests done and was leaving for Tennessee to have my surgery done when the Bariatric Center called me with the news that they got a letter from Medicare stating that "all bariatric surgeries must be performed at a state of excellence hospital". This means a big time hospital I'm assuming and the hospital I was going to was just a regular old hospital....nice but not state of the art. They can't do surgery there until Medicare inspects all these small hospitals that were doing the surgery and qualifies them. It could be weeks, months, or never knowing Medicare.

After I paniced I called Vanderbilt in Nashville but the bariatric center is closed for the day...it's 5:00 p.m. there. I know they take Medicare but I'm thinking everyone who was lined up for surgery in the rest of Tennessee (with the exception of Memphis) is probably pounding at their door wanting their surgery. I am totally bummed. I have spent mo. getting rid of an ulcer and now another major setback. I'm unsure what to do at this point....by the time they get documentation all of my tests may be outdated and I don't want to go through all that again.

Should I stay home, go to Tennessee and hope for the best, forget the whole thing (which is going to be difficult after all the work I've put into it) or just let things run it's course and hope they get qualified soon at the smaller hospitals?

HELP!!

PhotoNut · March 15, 2006

Aww Dody, I'm sorry. Dang. Well, I'm a firm believer that all things happen for a reason. Try not to stress over it too much until you can talk to someone at Vanderbilt tomorrow. As my mom always says, "Oh what a difference a day makes."

Everything will work out just as it's supposed to, you'll see.

*big hugs*

Dody · March 15, 2006

You are right, there is no point stressing over something I can't change. For now I'll wait until tomorrow and call Vanderbilt. My thoughts are...go self-pay and forgit about it, but then I think "why should I when I'm covered". I'm not sure what I'll end up doing. I hate to pay when I don't have too. Thanks for the reassurances. I guess I'll just go visit my daughter, enjoy, and what happens happens.....:hat:

PhotoNut · March 15, 2006

That's the best way to live life, Dody. Don't waste a minute stressing over things you can't control. And, if you do decide to spend the money on the surgery, well.. it's a good investment. In fact, the best one you can make. Go out and do something entertaining tonight. Buy some new clothes for your trip - not too many though. You won't be able to wear them for long. *winks*

Dody · March 16, 2006

I didn't go out and buy clothes today...was too busy making phone calls, but too late in the day to reach the hospital in Nashville. QVC delivered a whole bunch of stuff to me today (and the UPS man gave me his usual snarl) :hat: I'm thinking that Medicare is probably not going to change the policy on State Of Excellence Hospitals though. We have two of them in Boise (but St. Al's was NOT one before they added the maternity and NICU back) and now they are. All the other hospitals in Nampa and Caldwell are not State Of Excellence. They have to be performing heart surgeries and have neonatal intensive care units to qualify and how many small hospitals are going to add that...zippo.

Anyway I was wondering if your back had room for one more on it. Seems your hubby is doing great un-banded. He must have terrific willpower. I just thought maybe if you packed me around too you would lose weight at 3 times the rate

PhotoNut · March 16, 2006

*laughs* Dody, thats funny..

but no! LOL

Dody · March 16, 2006

You won't even give me a piggy back ride. Well, I guess you just aren't really a friend then. Just think of the weight you could drop lugging me around. The dr. would be amazed at you.

I talked to my daughter tonight. I've just said "the heck with it" and told her I'm just going to come down there, enjoy my vacation and pay for the darned surgery. I'll be darned after everything I've been through if I'm not going through with this. It's also way cheaper in Tennessee. I think you have to go self-pay or face obstacles with insurance for who knows how long. I thought mine was a walk in the park until this....but they aren't going to make these smaller hospitals into State Of Excellence Hospitals...there isn't a chance. Bad luck for all the band and RNY docs too that do their surgeries there for Medicare patients..

Se La Vie (is that right)? Who cares. I'm past ticked off now and going to go and watch American Idol. Stress isn't my best thing to deal with...I've had enough of it up to this point, so this little set-back is not permanent. Here's hoping the dr. lives until I get there...that's about the only other thing that could go wrong unless someone hi-jacks my plane or something. That could be OK if they take me to Mexico...ROFLMAO. I'd rather not have the surgery in that case. I'm convinced there is a Mexican dr. in Caldwell doing lap banding in his kitchen as we speak (he just doesn't have a degree).

I wonder if that durned Jack even knows we had a posse out looking for him.

PhotoNut · March 16, 2006

So youre going ahead with the previously scheduled plans? I'm glad. And you know, paying for it yourself will give you even more motivation not to cheat! LOL

I'm not sure if Jack knows or not. I put the link to that thread you started on his new thread. Don't know if he caught on to that or not.

DonnaB · March 16, 2006

Kitchen surgery! LOL and *shudder*!

I hate to think about you paying for a surgery you're covered for. I feel like, ANYONE with a shot of having their insurance foot the bill should push, push, push till they break through that bureaucratic BS, and crash through the almighty dollar barrier! I just hate that the insurance company is going to win. Even though it's not me! Man do I have issues. Good luck to you.

Why does your UPS man glare at you? Love me some QVC! HSN too. LOL I know, sick.

Dody · March 16, 2006

Kitchen surgery! LOL and *shudder*!
I hate to think about you paying for a surgery you're covered for. I feel like, ANYONE with a shot of having their insurance foot the bill should push, push, push till they break through that bureaucratic BS, and crash through the almighty dollar barrier! I just hate that the insurance company is going to win. Even though it's not me! Man do I have issues. Good luck to you.

Why does your UPS man glare at you? Love me some QVC! HSN too. LOL I know, sick.

They make deliveries just about every day to me...from Northern Nights sheet sets (I'm spoiled) to anything and everything...just ordered 4 pairs of Birkies and 3 coats from Dennis Basso. I think they just get tired of coming here and my dog barks at them every time. Doesn't matter...I'm a QVC and HSN holic and never disappointed in what I get. They have some great stuff.

As for Medicare. They are going to stop paying for the surgery at age 65. I thought I was in under the loop, but now they aren't paying anything unless you have a State Of Excellence Hospital perform the lap-banding. This consists of hospitals that have every facility available...open heart surgery etc. The dr's. at these hospitals in no way take Medicare patients, and I'm not about to wait for them to start. I hate the mess with the insurance companies too, but I'm just going to say the heck with it and pay for it. I don't have the time or the energy to mess with Medicare of all people. They aren't going to ever qualify a smaller hospital as State Of Excellence........just isn't going to happen in my lifetime. I'm just tired of the hassle and I've been fighting it for a year now, so it isn't like I just started this yesterday. I don't have the time to wait, and all my tests will expire and need to be done again, and the last thing I want is to go through all that again (especially the upper GI), so I'm just paying and they can kiss my big, shiny, white behind :hat: