So Frustrating!

[Ab1986 14]

So I have done almost a year of Nutritionist visits. I have lost 26lbs. I went Wed for my psych bariatric eval and passed. Then yesterday I went for orientation and my consultation with the surgeon. Everything went well, they said I should be able to be approved. They gave me a checklist of things that both the doctor and possibly my insurance would require.

Nutritionist eval and documentation 6-12 months

^done

Psych bariatric evaluation and recommendation

^done

Letter from me outlining why I want surgery and what I am suffering from

^done

Cardio clearance- EKG, stress test

Gall bladder Ultrasound

Blood work

Endoscopy

sleep study and pulmonolgy clearance

^need referral and scripts for the above from PCP

My surgeon is in Ocala, my PCP is in Clermont and I live in Orlando. I decided to stop in my PCP office on my way back to grab the referrals and scripts (he works in a walk in clinic) and he asked that I get written documentation from my INS company of what they wanted to have submitted for approval of surgery before he sends me for clearances to have the surgery.

Called insurance company and NO one will give me written info because the procedure is only done in times of medical necessity and each case is decided on a case by case basis.

I go back in with the PCP and he says he will not give me any referrals or scripts for tests until I am approved for the surgery through my INS company.

INS company verbally said I had to have "6-12 months diet documentation from a nutritionist/physician, Comprehensive pre/post op plan with a Bariatric program, clearance from Cardiologist, Gastroenterologist, Documentation of No Endocrine issues that could be causing the morbid obesity and a BMI of over 40, documentation of any co-morbidities". They said if all the appropriate documentation is not submitted it is an AUTOMATIC Denial.

I told the doctor this. I showed him the emails between me and a supervisor at my INS company with telling me that "There is no written procedure to follow for a MAGICAL approval".

I have the option of changing my INS plan with a good enough reason. Should I just change it, find a new PCP and INS? I already checked with my surgeon and they take all of the other insurance options I have to switch to.

Ugh I am so frustrated. I feel like no one wants to help me.

:-(

[Vicki Loichinger 444]

How crazy is that. You are right to feel nobody wants to help you cause that is how it feels. It is like nobody wants to be the one to have their name tied to a decision. Why will the baratric doctors not order these tests?? I know that they keep referring us back to our PCP and then PCP refers us back to surgeon. Nobody will just take the whole picture. I feel your frustration. Makes me want to scream.

I am going through a little bit of this with sugery scheduled for Wed, but need a Gyno doc to clear me (which i don't think he will) and don't see him till tues.

I want to scream for all of us.

I am not sure what to advice you to do. Hope somebody else has a good answer.

Changing insurance and PCP may be the answer.

[Ab1986 14]

Oh no! Can you see another Gyno? I would really want to cry if I was that close!

The Endoscopy and AnX test is being done by my Surgeon. He said my PCP can do the 12 lead EKG. But I need a referral to the Cardiologist to get approval for a Echocardiogram and a script from my PCP for the GallBladder ultrasound.

My PCP says he doesn't want to waste $$ on those test that I need for surgery clearance before my INS company says yes.

In his opinion the Ins company should make a decision based upon the Nutrition, Psych, Bariatric doc and The info from the PCP and say yes or no based on that info and THEN the INS company should say to get clearance from the specialist And the Clearance tests.

Which I understand what he is saying, but the insurance company wants it all done then will give approval.

I'm trying to find out now, what the requirements are for the other insurance companies I can choose, so I will know if I can use all the info I already have or if I have to start all over.

I really, really hope they Gyno give you clearance!!!

[Vicki Loichinger 444]

Tuesday was the soonest I could get in to see any Gyno. This one isn't mine, he was just in the practice when I had my boys nearly 30 years ago. My family doc is all I have seen in several years for paps and stuff. So I find out last tuesday that I have to do this and start calling around and even this doc's nurse didn't think I could get in, but she put me on hold and came back with this coming tues at 11. I just can't see how someone who doesn't know me could say it was ok to have the surgery on Wed. Even with the ultrasounds and an exam.

I understand your PCP and he is right, but it just doesn't work that way it seems. Nobody plays by the same rules, PCP, Surgeon, Insurance and then all the other specialists in between. It is crazy.