San Diego Gal w/Pacficare HMO just beginning the journey!

[ShannonS 0]

Hi

I am Shannon from San Diego, CA. I am just beginning my journey here in the banded world. I have done some initial investigating and have my first PCP appt on Tues to talk about this option and all my medical problems that have come about because of my weight.

I had my second child in May of 06 and topped the scales at 300lbs when I delivered. Due to breastfeeding, I went down to about 240. I ahven been b/fing for about 10 mos now and am back up near 300.

My BMI is about 41-43, I have HBP, a foot problem, back problems, bd knees, bulging leg veins, and the list goes on.

I have Pacificare HMO. I am looking forward to learning about how to better my life and live long enough to see my kids have kids and them have kids. LOL

Any advice on dealing with Pacificare HMO, dos/don'ts will be greatly appreciated!:kiss2:

[marathinner 1]

Hey Shannon...

I'm also a San Diego gal and my surgery is scheduled for 2/5 with Dr. George Mueller and the Sharp Hopsital program. I initially started with Scripps Weight Management (Dr. Lee) went thru all the usual requirements (orientation, support groups, dietician, psych eval etc) I was well on my way to a surgery date when I found out my insurance requires the surgery be performed at a Center of Excellence....which Scipps Green is not. Fortunately, I didn't have to start over with the Sharp program (thank god) and after I went to my consult and medical clearance my insurance approved me in less than 2 days! I have Pacificare HMO as a secondary insurance thru my husband and the Sharp program does not accept it. I do know however, that Scripps does. Oh...and I had the same issue with the UCSD program and the Center of Excellence things. My advice is talk to you insurance and find out what they require. I believe they use the standard protocol of most other insurances companies. Get your appt's lined up back to back...that will speed up the process. Ask questions when you don't understand something. Request your medical records for the past 18 months so you have documentation of all the ailments you talked about in your post. But most importantly, STAY DILIGENT. Be you own health advocated and MAKE IT HAPPEN!! I'm happy to talk to you more about my experince with San Diego programs and where I'm at now with one month until I'm banded!! Us San Diego gals gotta stick together. Congrats on making the decision to take this journey. These board are great and you will get a ton of wonderful info. Hope to chat soon!!

Amy

[sweetone 0]

I too live in San Diego, and have pacificare hmo.I think it also matters who your medical group is, and whether your primary care dr. will give you a referral. I belong to sharp community medical group.My best advise is call pacificare and ask them directly what the requirements are and what is covered. There is alot of confusion and wrong info from all the parties involved. The requirements also change frequently! I was found out I needed 6 mo medically supervised diet and a 6 mo healthy roads program, which is basically phone support. One week before completing my 6 mo program, the requirements changed and they no longer are requiring the 6 mo diet or healthy roads. I am finally going for my surgeons consult feb 14th with Dr. Mueller. I initially attended Dr. Callerys seminar, but at the time he was not performing the lapband. Best of luck to you!

[ShannonS 0]

My medical group is Mercy Physicians medical group. My dr was willing to go above and beyond to help me. But it has been 2 weeks and I havent heard anything. I am calling this morning to see if they are open and what they have found out.

Thanks for all the advice! It is very helpful!