Holy crap

kjangraw · January 14, 2007

Ok, so I had my first seminar yesterday and because I had been to one about 6 months ago, I knew what to expect. There were about 150 folks in the room and there were no seats, people standing and sitting on the floor, it was PACKED. Kids running around, people fighting over surveys, because there was only a few. It was a mad house........................

So, they proceeded to tell us what their requirements were, meaning the hospital requirements. They are as follows

Meeting with the nutritionist

Psych Eval

Loose 10 pounds

And no less than 2 additional seminars, so yesterday was seminar 1 and they only hold them once a month so I have to wait another 2 months at least, not a problem but dont understand why I have to hear the same thing over again twice, they hold the same exact seminars every month, folks I undestand its part of the committment to the surgery but how bout meeting with the nutritionist twice to quiz me if I know what I need to know, not sit in a room full of screaming kids, you couldnt even hear what they were talking about, the mic didnt work, and they had a wacked out fitness lady who everyone was laughing at because she was such a fruit cake

Sounding pretty standard, right? So somebody asked what we could be doing to push though approval with the insurance and they said they dont contact the insurance company until all of the pre-op work is done.

So somebody asked, well what if we do all the pre-op stuff and we dont get approved? The nurse said well I guess your out of luck.

I thought you guys would think these questions were pretty funny and would love to hear your reactions.

What if we cant loose 10 pounds?

What if we dont have anyone to watch our kids?

If we dont work can we get a date sooner than the ones that work?

Is welfare going to cover the surgery?

Do I live on another planet or was this just CRAZY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I beleive the surgery team and the nutritionist were very straight forward and I have confidence in the physician, etc.......but do you think it was so crazy because there were so many people there? Maybe it was unorganized? I felt like I was at a flea market......

Any thoughts?

staceylca · January 14, 2007

Just thought I would ask Where did you go? and there are other DOCTORS . GOOD LUCK

kjangraw · January 14, 2007

I am in NH and my insurance will only let me have the procedure done in NH. I think the hospital and staff are fine.....Maybe I was just expecting something else, who knows.......

ReneBean · January 14, 2007

I would try going to the next town if there are no other docs there. That crap about waiting three months to show your dedication sounds pretty stupid. Since you really can't get an approval from the insurance company without the tests and stuff, you will have plenty of time to think about your decision.

You do need the medical testing and the psych eval - but the ten pounds and the three seminars is all them.

1) Contact your employer - make sure that the employer's contract with the insurance company doesn't have an exclusion against bariatric surgery for treatment of Morbid Obesity. **be sure you phrase it that way - cause nobody covers standard weightloss treatment. It has to be medically necessary as a treatment for Morbid obesity.

2) Call your insurance company to be sure they cover. Ask the same question, bariatric surgery for the treatment of Morbid Obesity.

Once you know that there is no employer exclusion and your insurer covers the procedure - THEN start the medical testing process. Get your tests together and sent to your doc - and they bundle it all up and send it in to the insurance company for an approval. What they have to get is the insurance company's agreement that the surgery is medically necessary... and no surgeon will operate without it.

Other than that - you shouldn't have to do anything. Not lose ten pounds, not say pretty please, not beg at the feet of the almighty doctor for the permisson to be treated. If you are getting that kind of attitude or vibe - then run the other way, fast.

Hugs and good luck!

kjangraw · January 14, 2007

I felt discouraged, I really did and I will see if there are any other programs. This hospital happens to be affiliated with my primary and they have the most experience with the surgery in the state. The leader of the seminar couldnt beleive how many people there were, it was a mad house but I think it was because people were mad they had to stand, people were fighting to get in line. I swear it was like being at a flea market. All the questions they asked were so stupid. Not one person asked any smart questions. There was one point where the surgerons assistant said that unless you diet and excercise, the surgery will not work for you. Some lady stood up and said, arent you sappose to loose alot of weight after the surgery? The PA said, well yes, but it takes alot of work on your part too and she got mad and crossed her arms. Im wondering if the leader was aggrevated, maybe overwhelmed....Maybe they were aggrevated with the lack of intelligence.....Who knows.....

My insurance does cover the surgery, I talked to my HR person and there are no restrictions. The owner of the company I work for has his wife, all 3 kids, grand kids and brother who all work for him and share the insurance so basically when he signed up there were no restrictions at all.

ReneBean · January 14, 2007

So now you know you are probably going to get insurance coverage, it's just a matter of meeting your surgeon's requirements. Go talk to the doc. Let him know that time is money or life is precious, or whatever you think he will understand.

Let him know you understand the basics of the procedure and that you will be responsible for doing all the right stuff and making the right food choices.

Impress upon him the need to get this done so that you can get on with it already - instead of waiting for 3 months - OR - ask him if you can attend seminars for other docs to fulfill his 3 seminar requirement.

Since getting the pre-determination from the insurance company will probably take a while, I see no reason to wait for 3 months before you even START that process... Geez. If I had done that it would have taken almost a year. It took about 4 mos to battle my insurance company.

Hopefully yours will be easier than mine was. Mine said I was too fat for lapband and only wanted to pay for Gastric Bypass. Uh Huh. Yeah. Sure. Whatever.

The state insurance board seemed to agree with me... thank goodness!

I would try talking to the doc. I can't believe that he really thinks everybody should wait for 3 months just to prove something. If he does - if he really does - then find a different surgeon.

Best of luck in getting approval. I love my band and feel that it was worth every minute of agony fighting and waiting for my stinking insurance company.

Hugs!!

kjangraw · January 14, 2007

I agree, its worth the wait and Im willing to stick it out. However, I anxious to start posting some good news.........

Good night.

Kelsy · January 14, 2007

Wow, That sure does sound like a flea market!

LOL @ the Welfare question.

I still had my appointments while i was attending the seminars. The one's at BIDMC in Boston are held every other Thursday. So i don't know why you have to wait so long..

When i went to my second session, I was 1/2 hr late and i snuck in. The place as packed too! And people were standing. I saw the nutritionist and asked her if we had to stay for the -entire- thing because it was the same as the last. She didn't seem to mind if we stayed or left.

So me and my mom ducked out while the questions were being asked. You could be there for hours !! But that was fine, because i stayed through the whole thing the first time i went. Well, until all my questions were answered atleast.

Just make sure you start booking your appointments. I had my first appointment before i went to any info session! They just said "make sure you attend atleast 2" and i did. So i would get on the ball and start the process in the meantime. I don't see why you have to keep waiting.. Unless you've already got things rolling!

Kat817 · January 14, 2007

Neither my Dr. nor insurance required that I attend any certain number of seminars. Now I did sign up for the seminar, and she ask how many would be attending, I said I thought 2, she ask if that changed, to please let her know as space was limited. When we got there, there were seats for everyone, it was held at the surgical clinic, they had a video presentation, the surgeon talked, discussed the different surgical options--the usual. Then there was both a man and a woman who he had performed lap band on, and they spoke, and answered questions. He answered all the questions ask---but he was your typical surgeon, a bit smug! When a good question was ask--he said so "GOOD question---I like that" then he would answer. If it was a no brainer-he kinda did the bored with it all look and answered it, but did not elaborate. One woman said she couldn't exercise, that she thought the reason for having surgery was to lose the weight without it. He told her point blank, if she was not willing to TRY to do some exercise, he was not willing to TRY to save her life! He was not rude---just attempting to make her see, this is her life!!

He is not the Dr. that did my surgery---I do use him for adjustments tho, and he is still very vocal about doing your part. He has jumped on my SIL for eating wrong foods, and told her the band may never work for her, since she is not working it.

I agree, I would start any and all appointments I could, and start gathering info together in one spot. Bringing in medical records from other Dr.s, if you have it....go ahead and make an appointment with him, and show him what you have and make sure he knows you will be at the next seminar---see if he will make an exception when he realizes YOU are not waiting for welfare to pay for yours!!! Keep a copy of all records you can gather---let him see how organized, and prepared you are. It is only going to benefit you to lose the 10 pounds anyway---just less you have to lose later!!! And we have all dieted, we know we can lose 10 pounds, our issues are with keeping it off. Record your weight and measurements, and let him know where you are on the 10 pounds....just in general, let him see the responsibility.

While I do not agree with his methods so much---the fact that he does have a corner on the market it sounds there---and he is obviously getting some real winners wanting an easy way out, it sounds like he is simply putting up some hurdles, to see who will even bother to jump through them. How you do affects him as well---Dr.'s have to tell you what their statistics are if you ask---how many bands he has done, what the complication rate, infection rate etc. is. If he is getting people who do not have any intentions of complying---you can see why he puts up a few obstacles. Let him see you are not one of the looneys!!! And you are prepared to work with the band to succeed!

Hang in there!!!

Kat

2bthinagn · January 14, 2007

ReneBean.....the Dr said you were TOO big for lapband? I wonder what he considered too big, where did you have the surgery? I have never heard that. That scares me, I wonder if a Dr could say that to me. I want the lapband becuz it is the least invasive of all the options. I have been looking into this for over a year. I have Medicare and that stopped everything when they decided to cover lapband last year. I got discouraged and gave up. I have now found a Dr and hospital that will take the Medicare but looks like it will be at least a 6month wait. And it is a 2 hour drive from my home!

Alexandra · January 14, 2007

Kerry, the popularity of bariatric surgery is resulting in some of these mad houses. My surgeon's practice has had to scramble to keep up with demand, though now they have it all under control. I wouldn't hold any of this against the doctor. I imagine there aren't a whole lot of doctors doing this surgery in New Hampshire, so the ones who do are getting slammed.

They'll have to come up with a better way to manage the crowds, that's for sure.

kjangraw · January 14, 2007

Yes, they seemed very overwhelmed, ran out of forms for us to fill out, kept having to run to the copy machine to make more copies. People were literally, and this isnt an exaggeration, following the nurses around who were trying to pass things out. One of the nurses asked everyone to be quiet and said,"If anyone has any questions, please write them down and put them in the comment box as I really need to concentrate of getting everyone the information they need to fill out to take home." As soon as she said that, people started asking her questions. Duhhhhhh.....

So, I took my forms home, had all my medical records prior to the meeting which also included the discussions with my primary about the surgery, my expectations, my physical, everything.......included all my receipts from WW, etc....and sent a big package on Friday evening, the day of the seminar.

The nurse also said at the seminar that the folks who filled out their information forms from the prior seminar, which was in the middle of December, would hopefully be entered in the system soon. So that means it takes almost a month for you to even be entered into their data base.

I think one of the reasons I am not going to attend another seminar in another facility is I dont want to see that I am jumping around to get past rules or regulations<-------does that make sense, meaning looking too anxious, not willing to live by their rules......

I will however, call them this week to make sure they received my packet and start my other appointments pronto, I am also going to start my diet to loose more than than the 10 pounds they require and hopefully they may see that I am indeed serious and not looking for an easy way out.

DrHekier · January 14, 2007

ReneBean.....the Dr said you were TOO big for lapband?

I think she implied the insurance wouldn't cover the Lap Band. We have seen some insurance policies in the past which strangely state that if your BMI is greater than 50, you can only have the gasric bypass not the Lap Band.

Maybe that's what she was referring to.