Insurance Approved but Dr. Denied

[kparadisek 115]

Ok so my insurance company has approved the revision from band to bypass now the Dr office is talking about having a committee hearing at which time they will decide if I need more nutritionist consults, more psych evals or what. I'm pissed now because I think they are going to say I need to do more. I've already done the one year program with my insurance company which included bi weekly meetings and weight loss programs. Should I start looking for another Dr?

[IChatman 24]

Ok so my insurance company has approved the revision from band to bypass now the Dr office is talking about having a committee hearing at which time they will decide if I need more nutritionist consults' date=' more psych evals or what. I'm pissed now because I think they are going to say I need to do more. I've already done the one year program with my insurance company which included bi weekly meetings and weight loss programs. Should I start looking for another Dr?[/quote']

Yes I would... I had my pre op.appointment on Feb 5 from there my surgery was scheduled for April 23 remember you are the costumer and have the right to choose.

[Sue0325 0]

I went through the 6 months nutritional consults and was unhappy that I had to wait but after I had my surgery I realized it was worth the wait. I took the 6 months and followed the Portion Control and used Meal Replacements. I lost 76 lbs before my surgery and 56 lbs thus far after surgery (Oct. 2012). I found I needed that time to realize I could follow portion control for the rest of my life. I know it's hard to be patient but if you've researched your surgeon and found he is a good doctor with good credentials and plenty of success stories wait and see what they say. Each doctor may have his own guidelines they want you to follow before surgery. He may say your ready to set your surgery date. If you're not happy with his decision check out other doctors.

[TinyMamiOf3kids 1,280]

Yes find someone else

[kparadisek 115]

Thank you all! He is the same surgeon that did my lap band. I can't say that I researched him thoroughly the first time. He did my step moms surgery so I went to him. My thing is he should have told me this in the beginning especially after I had to do a 12 month program. I'm looking for a new Dr. Now.

[Kurstin 72]

Once my insurance approved me, my surgeons office also did a board meeting and decided if they would perform the surgery (mainly because I was a smoker and she haaaates smokers) but, from what I understand it was routine for them to go over your file again before agreeing to operating. They are taking a huge risk by saying they will... Your surgeon has to have faith in you just like you have faith in them. Luckily, they approved me without a problem. But, if they would have denied me based on something ridiculous like being a PREVIOUS smoker.. I would have found a different surgeon too. (She did make me take a Nicotine test though to prove I had quit)

[oldoneyoungagain 200]

I am having my band out, just waiting the the approval. I suggested they do the RNY at the same time. The surgical nurse said insurance company wouldn't allow the dual surgery and I would have to go through 3 months of weight management with PCP, another psychology test (which I had done today. I am lucky my psychologist is the one that got me in with my new doctor and is the psychologist for that practice.) then the bypass. Hopefully I don't have to get the approval from the clinic's board. I am already upset because the band has to come out (I am one of the patients that never had an issue, even though it has now slipped. In fact I lost 4 pounds since I seen my new doctor three weeks ago). So really will be upset if I couldn't get the approval of the board if it would come down to that. I am afraid that since this clinic didn't do my band, and I am new to them, they could deny me because of age as their cut off is 72 and I'll be 71. My heart goes out to all of you and the hoops that we all seem to have to go through just to better ourselves, become healthier and it takes just one person who says you didn't do what you should have done before, so you probably won't do it this time either so I can't approve another surgery. All we can do is hang in there and wish for the best.

[kparadisek 115]

I am having my band out' date=' just waiting the the approval. I suggested they do the RNY at the same time. The surgical nurse said insurance company wouldn't allow the dual surgery and I would have to go through 3 months of weight management with PCP, another psychology test (which I had done today. I am lucky my psychologist is the one that got me in with my new doctor and is the psychologist for that practice.) then the bypass. Hopefully I don't have to get the approval from the clinic's board. I am already upset because the band has to come out (I am one of the patients that never had an issue, even though it has now slipped. In fact I lost 4 pounds since I seen my new doctor three weeks ago). So really will be upset if I couldn't get the approval of the board if it would come down to that. I am afraid that since this clinic didn't do my band, and I am new to them, they could deny me because of age as their cut off is 72 and I'll be 71. My heart goes out to all of you and the hoops that we all seem to have to go through just to better ourselves, become healthier and it takes just one person who says you didn't do what you should have done before, so you probably won't do it this time either so I can't approve another surgery. All we can do is hang in there and wish for the best.[/quote']

I wish you well with your process! I'm sure everything will workout for the best. Keep me updated on your progress!

[btb2013 84]

Ok so my insurance company has approved the revision from band to bypass now the Dr office is talking about having a committee hearing at which time they will decide if I need more nutritionist consults' date=' more psych evals or what. I'm pissed now because I think they are going to say I need to do more. I've already done the one year program with my insurance company which included bi weekly meetings and weight loss programs. Should I start looking for another Dr?[/quote']

Yup

Hw 245; Pre-Op(RNY) 225.6; Surg Date 2/26; CW 198.4....GW 145

[nclori2002@yahoo.com 0]

Once my insurance approved me' date=' my surgeons office also did a board meeting and decided if they would perform the surgery (mainly because I was a smoker and she haaaates smokers) but, from what I understand it was routine for them to go over your file again before agreeing to operating. They are taking a huge risk by saying they will... Your surgeon has to have faith in you just like you have faith in them. Luckily, they approved me without a problem. But, if they would have denied me based on something ridiculous like being a PREVIOUS smoker.. I would have found a different surgeon too. (She did make me take a Nicotine test though to prove I had quit)[/quote']

Hi, If you dont mind me asking ....How long were you nicotine free when she tested you?

[Kurstin 72]

Hi' date=' If you dont mind me asking ....How long were you nicotine free when she tested you?[/quote']

I had quit in December and took my nicotine test in April. However, I had had a few puffs of a cigarette when I was out with friends one night at a bar. That was in February I think. But, never actually smoked a full cigarette since December 4th, 2012

Surgery Date: May 2, 2013 - Amount Lost: 26lbs

[oldoneyoungagain 200]

I wish you well with your process! I'm sure everything will workout for the best. Keep me updated on your progress!

Approval came through for removing the band. Surgery center called yesterday giving me all the do's and don't on May 23rd. Scheduled at 1:00 PM, from my passed experience, this is the doctors first surgery appointment. So should be home later that night. Go back on the 30th and going to discuss the next steps to RNY. Don't want to wait any longer than I have to because #'s will probably start back unless I totally starve myself.