VENT! Suprise Dr. Doesn't Take Insurance Anymore

[txaberry 0]

I'm approved for surgery and scheduled for a date. I started this process in July 2007 and followed the whole system etc... By accident I found out that my surgeon is no longer an aexcel specialist as of 1/1/08. Which means now I have to pay 5000 instead of the 2000 for in-network! I feel totally frustrated!! I'm saving up for it as it was. My insurance told me I can find an aexcel surgeon and my approval will be ok. So I find one, and try to make an appointment but OH, I have to attend the seminar before I can even make an appointment!!!! WHY IS THIS SUCH A HASSLE??? And now I have no idea how much longer I'll have to wait for surgery!! I feel super frustrated and really let down by my original surgeon.:scared2:

[Elisabethsew 50]

Welcome. I know it can be frustrating having to jump through the insurance hoops but it will be worth it once you're banded and on the road to a healthier you.

[SuzanneG 1]

You may want to call around. I was having trouble getting through the process with my surgeon and found out that several surgeons in my area were willing to accept the seminar, psych eval, etc. that I had already completed.

I know it's frustrating, but don't give up! It's totally worth it.

[hopeinapril 1]

Bummer TXABERRY!!! It really sucks when you do what you think you need to, then BANG, you get hit with something like this.

Did you tell the new doctor's office that you had already been approved? Sometimes they don't listen closely and just give you the rote answer. Especially if you tell them that you are already approved.

[WestCoastFatGuy 3]

I'm approved for surgery and scheduled for a date. I started this process in July 2007 and followed the whole system etc... By accident I found out that my surgeon is no longer an aexcel specialist as of 1/1/08. Which means now I have to pay 5000 instead of the 2000 for in-network! I feel totally frustrated!! I'm saving up for it as it was. My insurance told me I can find an aexcel surgeon and my approval will be ok. So I find one, and try to make an appointment but OH, I have to attend the seminar before I can even make an appointment!!!! WHY IS THIS SUCH A HASSLE??? And now I have no idea how much longer I'll have to wait for surgery!! I feel super frustrated and really let down by my original surgeon.:mad:

I REALLY feel for you. I had originally chosen a different surgeon, as well. He was close to home and had tons of experience with the lapband. He had just transferred to my local hospital from a well-known midwest hospital a few months before. I considered myself very lucky. I went through the seminar, psych evaluation, pre-testing... everything up to requesting approval from the insurance company to schedule the date. That's when the office told me that they weren't a 'center of excellence', as required by my insurance. But, they offered to let me do the surgery self-pay for $15,000! I was FURIOUS! They knew all along what my insurance was (Blue Cross of California), yet they strung me along hoping that I would get deep enough into the process that I'd go along with the self-pay.

I actually gave up at that point because I had already investigated all the surgeons within driving distance of me (I thought) and wasn't comfortable with going to any of them. After a month or so of cooling down I started searching again and found that I had overlooked an incredible surgeon who was only 1-1/2 hours from my home. I called his office and learned, like you, that I would HAVE to attend the seminar again. No exceptions. Angry Angry Angry, I was.

Well... fast forward.. I attended the seminar (where I learned nothing more), but all my other pre-surgery testing (including the pysch evaluation) were accepted by the new surgeon. In the end, the only real inconvenience was the seminar.

Whoever said that everything happens for a reason was soooo correct in this case. I'm very happy that I ended up with the surgeon that I did. In retrospect, I wouldn't change a thing in the process that I went through to get banded.

I wish you the best of luck in your journey to bandland. It WILL happen!

[StLouisGal 1]

I think most surgeons require a seminar before making an appointment. If you already have insurance approval it shouldn't take too long to get the other ducks in a row. I had to wait for insurance approval before they would give me an appointment with the doctor. That was pretty frustrating too.

I had originally chosen a different doctor but my inusurance wouldn't pay for her. Now I am about 30 minutes further away but I like the center much better and it is costing me a lot less.

Good luck to you. My advice is, sign up for the seminar as soon as you can and go from there.

[faithmd 14]

The two stories above me underscore the absolute importance of CALLING YOUR INSURANCE COMPANY and asking them WHO THEY COVER before you marry yourself to a surgeon!

Also, you need to regularly check with them to make sure they still cover with your doc. Many things change after January 1st. I got hosed on that one a couple of years ago when trying to start this process, I changed insurances because my ins at the time didn't cover banding, so I went with one I was told would. Well, you guessed it, after Jan 1st, they didn't! So I had to wait another year to find another one that would pay for it.

Ins co's are ridiculous!

[QTkidsmom 0]

You may want to see if they will "grandfather" you since your care began when the provider was in-network. Often times, that makes a difference. Talk to your carrier, a manager there would be best.

[txaberry 0]

Thanks for all your replies! I haven't decided what I'm going to do yet, I signed up for another seminar so we'll see how long I have to wait to get a date with him. I appreciate the encouragement!!

[la8again 0]

I had the exact same thing happen to me. I had call my insurance company (Humana) to check my benns and they told me that the doctor that I had chosen was covered. When I got to the doctors apt and was back in the office, the insurance lady told me that my benns had changed Jan 1. I had called Humana on Jan 12 and that is when I was told it was covered. What had happened was that the 2008 plan wasnt in yet so they just told me plan benns for 2007. So as of Jan 1 I have to go to a center of excellence. I tried the whole thing of making them pay because they had told me the wrong thing after when the plan had started. They told me that there were not any exceptions. Even if I had been approved and my surgery was in 2 days from that they would have not paid. I think that it really sucks, but I do know how you feel. I am also having to start the whole thing over again. I went to another simanar that night and had my first apt today. Now on top of everything else my insurance company requires a 6 mont diet prior to submission. That started last week. I was so angry when I found that out I jst cried all night. I was suspose to have my surgery next week with the first doc and now it will be August.

[txaberry 0]

Well, I went to the seminar for another surgeon last night. Today I called my first surgeon and made arrangements for my file to transfer and they called me back a few hours later and told me I was "grandfathered" because I was already their patient before he dropped the aexcel program. I called insurance and they told me I was approved with him at the highest level of payout (in network) so today had some good news. Thanks for all your support.:biggrin:

[fayezy 0]

So happy for you-

I just started my 6month diet with my PCP and I had some mixed emotions but after the appointment I feel everything happens for a reason. August would be a better time of year for me-youngest graduating from HS and going out of state for college so the time delay would be better.

[lsuza 0]

Any doctor who does the Lap Band can finance the band a 11.99 APR for up to 84 months through a company called CARE CREDIT - tell him to call his Allergan rep for details