WELLMARK BCBS OF IOWA

[saints92 2]

I am so frustrated right now. I have submitted twice to Wellmark for approval of the sleeve, both times denied. This last time the only denial was no proof showing chronic corticosteoid use. Now, I have sent in all my notes from my ENT Doc showing my Flonase use and oral steroid use and a letter from my ENT doc saying yes I am on a corticosteriod and have been for the last two years since nasal surgery and will continue to take it with my chronic allergies. What more do they need?????????????? I called my insurance and they are setting up a peer to peer review so the doctors can hash this out. I am so upset. I have worked so hard to get this completed and approved and now another snag. I am determined to win this case and so is the insurance department at Dr. Eibes office. They can't believe it. Any suggestions???

[Kaywieny 2]

I am so frustrated right now. I have submitted twice to Wellmark for approval of the sleeve, both times denied. This last time the only denial was no proof showing chronic corticosteoid use. Now, I have sent in all my notes from my ENT Doc showing my Flonase use and oral steroid use and a letter from my ENT doc saying yes I am on a corticosteriod and have been for the last two years since nasal surgery and will continue to take it with my chronic allergies. What more do they need?????????????? I called my insurance and they are setting up a peer to peer review so the doctors can hash this out. I am so upset. I have worked so hard to get this completed and approved and now another snag. I am determined to win this case and so is the insurance department at Dr. Eibes office. They can't believe it. Any suggestions???

If the doctors and the insurance company are having a peer to peer review, I would assume that would mean that Dr. Eibes will be pleading your case with your insurance company? I don't know how this works, either, but I do know this... Dr. Eibes and all the doctors pretty much at Des Moines Bariatrics are just not great doctors but great advocates for people that suffer from obesity. They proved that to me with all he and Dr. LaMasters did with Iowa Legislature when they tried to eviscerate the coverage inside Medicaid.

Have you written a letter about yourself to your insurance company? That would be the only other thing I would suggest, because it sounds like you've done what you can. I'm awaiting word from my own insurance company right now, I can't imagine how hard these last few weeks have been for you. Stay positive and best of luck.

[saints92 2]

Thanks so much. I have wrote a long personal letter to them as well. I am putting it in Dr. Eibes hands now. I am praying he can get them to understand. I am beyond frustrated, but know it will happen, just takes time.

[saints92 2]

Well, Dr. Eibes did a peer to peer review with Wellmark BCBS and explained that I meet all requirements. I inhale a corticosteroid daily and have for 2 years and my doc wrote not saying this will continue. They are saying I am not a habitual corticosteroid user so won't approve the sleeve. GRRR Dr. Eibes is doing a upper scope on me Monday and looking for gastritis. If I have gastritis, then Wellmark said they will approve. This is so ridiculous. Wish me luck on Monday!!!

[saints92 2]

I WAS APPROVED FOR MY SLEEVE!!! I am waiting for my official letter from BCBS and then I am making appt to see Dr. Eibes to get my surgery scheduled. I am so excited. I have been working on this for months!!!

[Kaywieny 2]

Congrats! Get ready for the rollercoaster ride. My surgery is exactly three weeks away and time thank God, IS moving quickly. Good luck!

[saints92 2]

I just went to Dr. Eibes today and am scheduled for surgery on October 25th....YIKES!!! I am excited, scared as hell and all in one!!!! I have my heart set! I am ready to get to the surgery date!!! I wish you nothing but the best and we must stay in touch....we will be done like days apart!!!

[Leederz 49]

First off congratulations ! I too have BCBS of Iowa, and they denied for not having the chronic corticosteriod use as well, I went to ENT who prescribed nasonex and gave me a running prescription to be filled for 12 months. When they say history of chronic use does that just mean I have to be using it for at least a 3 month period? I have a feeling Im also going to run into another snag with this one. Any type of info on that would greatly be appreciated I tried to call them myself and the customer service couldnt even explain it to me. Thanks so much =)

[saints92 2]

Hello there- Dr Hoisington wrote a personal note as I am on 2 nasal sprays and one is a steroid, They said they don't count nasal steroids for that rule. I have to had a EGD then it was approved. I am in the hospital recovering now from surgery. Wellmark just kept reading me the sheet of medical policies, I sent them proof that Flonase was a corticosteriod and still didn;t work. Very frustrating but I didn't give up. Good luck.

[Leederz 49]

Good luck

[andersonlj 32]

I got approval for my lapband through BCBS back in 2009. I had the surgery and lost about 90 pounds. Dr Eibes did my surgrery. In 2011 I stalled and was not able to lose any more weight and did not gain any either. My band was at max fill so I was stuck. I went to see Dr Eibes about having the lapband removed and have the sleeve done. They told me that my insurance would not pay for the surgery and that I would need to have 2 surgeries. The first would be to remove the lapband and then wait 2 month before they would do the sleeve. The cost of this surgery private pay would have beeb over $40,000. Obviously there are not many of us out there that have an extra $40,000 laying around to spend on surgery.

So I began my search for a surgery that I could afford. I found my answer with Dr F Garcia in Tijuana, Mexico. I initially had my reservations about going to Mexico as you hear alot of stories about Mexico in general.....dirty, dangerous etc. I did my research and actually spoke on the phone to a couple of patients of Dr Garcia's and they were very happy with the surgery and had no complaints about having the surgery done in Mexico.

I had my surgery on Dec 11, 2011 in Tijuana at Hospital MI with Dr Garcia. I could not have been happier with everyone that was involved with my surgery, pre and post care and the hospital. I also spend a couple of days in Tijuana after my surgery and was also please with the hotel accomodations and all that they did for me during my stay to make sure that I was comfortable and well taken care of.

When I got back from my surgery I called Dr Eibes office to see if they would follow me. I had heard that if you have surgery out of the country they will not. I thought that since Dr Eibes had done my lapband and that I had been a patient and compliant that they might keep me on. Well when I call I found out different. They dropped me like a rock and gave me no other options. Now I followup with my primary care doctor who checks my blood work on a regular basis and has been very supportive. If I do have any other problems that would require any hospitalizations and possible surgery I would go to Mercy as I would not want Dr Eibes or LaMasters working on me as an emergency patient as they would not keep me as a patient after my surgery.

If you do decide to go out of the country be prepared to be dropped by your doctor here. I would suggest checking before you have your surgery so that you have a plan when you return.

[Kaywieny 2]

I got approval for my lapband through BCBS back in 2009. I had the surgery and lost about 90 pounds. Dr Eibes did my surgrery. In 2011 I stalled and was not able to lose any more weight and did not gain any either. My band was at max fill so I was stuck. I went to see Dr Eibes about having the lapband removed and have the sleeve done. They told me that my insurance would not pay for the surgery and that I would need to have 2 surgeries. The first would be to remove the lapband and then wait 2 month before they would do the sleeve. The cost of this surgery private pay would have beeb over $40,000. Obviously there are not many of us out there that have an extra $40,000 laying around to spend on surgery.

So I began my search for a surgery that I could afford. I found my answer with Dr F Garcia in Tijuana, Mexico. I initially had my reservations about going to Mexico as you hear alot of stories about Mexico in general.....dirty, dangerous etc. I did my research and actually spoke on the phone to a couple of patients of Dr Garcia's and they were very happy with the surgery and had no complaints about having the surgery done in Mexico.

I had my surgery on Dec 11, 2011 in Tijuana at Hospital MI with Dr Garcia. I could not have been happier with everyone that was involved with my surgery, pre and post care and the hospital. I also spend a couple of days in Tijuana after my surgery and was also please with the hotel accomodations and all that they did for me during my stay to make sure that I was comfortable and well taken care of.

When I got back from my surgery I called Dr Eibes office to see if they would follow me. I had heard that if you have surgery out of the country they will not. I thought that since Dr Eibes had done my lapband and that I had been a patient and compliant that they might keep me on. Well when I call I found out different. They dropped me like a rock and gave me no other options. Now I followup with my primary care doctor who checks my blood work on a regular basis and has been very supportive. If I do have any other problems that would require any hospitalizations and possible surgery I would go to Mercy as I would not want Dr Eibes or LaMasters working on me as an emergency patient as they would not keep me as a patient after my surgery.

If you do decide to go out of the country be prepared to be dropped by your doctor here. I would suggest checking before you have your surgery so that you have a plan when you return.

WOW. I can't say I can't believe they wouldn't do your follow up care. It's been almost three months since my surgery. In the course of the last few months I have found out quite a bit and have tried to keep some speculations I've had to myself about Iowa Weight Loss Specialists. My experience with Dr. Eibes had been good overall, but I have some reservations about some stuff.

I have a blood test coming up, and then my 6 month check up in March, but it's my plan to see if my Primary Care doctor will 'help or even take over care afterwards. I thought Dr. Eibes was great, but there's been some issues that have come up that have concerned me, and it's with some of the policies/procedures or whatever they adopted as they have expanded. For example, originally when I went through orientation almost a year ago, before surgery, I was told by Dr. Eibes that they WOULD take out my gall bladder if I still had it. That wasn't the case when surgery rolled around, I was told they would leave it in so I could still benefit from it. I'm on Urosodial which makes my hair fall out, gives me Constipation, and after 6 months I will NOT be given a refill. I HOPE I'm still losing significant weight by then, but I don't know. I just think that I'll be a gall bladder case waiting to happen, because of medical history, etc etc.. And then, well, the clinic and the staff have grown so much over the last year, people in and people out, that it just doesn't feel so comfortable going there anymore...I've begun to feel like I'm on an assembly line, in a way. I also had problems with the insurance staff. I was not submitted for my surgery until 4 weeks later because there was only one gal and she was overwhelmed. Felt bad for her, but....not my fault. I was miraculously approved within 24 hours though after I was submitted. At the time though I was with Principal Insurance.

I don't blame you for not wanting them to follow up care if on an emergency basis. Frankly, I think it's cr*p that they refused to see you for follow up care. I was wondering if you ever checked with the Grinnell, IA bariatric clinic, (I don't know the name) or no because of insurance reasons? My insurance wouldn't cover because they are out of network for me, otherwise I would just go there because it's only a few miles away. I also don't know anyone who has been to that clinic.

BTW...I do believe the OP of this post did have her surgery.

[andersonlj 32]

Thanks for your reply as I thought that maybe I was the only one that felt like it was an assembly line. It seemed that I had a lot of frequent followup visits and since it cost me $40 each time it was adding up. They would weight me and say all looks fine and come back in 3 months. Well if that is all they want is my weight and to know if I am having a problem I could call them. Just seemed to be a money making thing. I only saw Dr Eibes the last time as I specifically made an appt with him and not the PA. I have nothing against the PA but if all they want is weight and to know if I am having problems then why not just a nurse visit.

Oh and after I called to have them get my records ready for me, weeks later the office called and wanted to know why I had not called to make a followup appt with Joel. I told them that I had just seen Dr Eibes and since they had dropped me as a patient that maybe they should pass the information along so that everyone knew and that they would not bother calling me again. I agree now that they are growing things are becoming less personal than when I first went.

I had not thought of the WLS in Newton and I may give them a call to see if they would follow me. Thanks for the suggestions