It's a bittersweet Update...

[glamischick 0]

hi everyone, a lot has happened in the last 2 months. First, i was put on a two month trial by my doctor. I had to lose a total of 10 lbs, five the first month and five the second month. So, i get a call from my doctors office which happens to be Dr. Horgan in la jolla, ca. They told me that my insurance denied me. Due to the fact that my doctor not being in the network of my insurance. So, it all came down to this, i believe that my doctor should have known that he was not within my network instead of wasting 2 months of my time and his time, right?!?!? I had to pay over 300 dlls already to him. And they wait for the last minute to ask for an approval and i was turned down. I had to cancel my appt that i had this monday for my final weigh in. After that i was suppose to get a surgery date. Now im back to square one!!!! Bummer! On the lighter note i already lost 20 lbs while all this madness was going on. Pass the 10 lbs i was suppose to lose and i did it all on my own :smile: now, where do i go from here??? Do i start a whole new process with another doc? Oh and by the way i appealed it (Dr. Horgan) I'm suppose to know like in 2 weeks what the outcome is....but i kinda feel like i cant trust this doc no more, i feel ive been cheated. Maybe the doctor is not even aware of whats going on and its his staff not him. Who knows, im so confused now. Any suggestions??? On another brighter note, today was the first day i woke up at 4 am to work out!!! Wow! I surprised myself....hope u all have a wonderful day today. Im at work now! God bless you all!!!

Edited February 11, 2009 by glamischick

[TQUAD64 9]

I don't know anything about your insurance, but with my insurance they gave me a list of bariatric doctors that were in the network, so there was no confusion as to who was a provider and who was not.

Can't your insurance company tell you which bariatric doctor is covered in the network, so you don't have to waste your time?

[BethFromVA 5]

I would also think that any prerequisite procedures you did should work towards the operation and not have to be repeated... but find out for sure.

[HeatherO 7]

If anything, you have to be careful with insurance. I also don't think you will have much luck with your appeal so you should get the ball rolling in finding a doctor that is in network and find out if they will credit any previous time/visits towards yoru requirements.

You can't really rely on the doctors offices to verify all aspects of your insurance . . . although they should verify everything from the first visit, if they don't, you are the one who suffers the consequences. However, there are just way too many denials that come from lack of information that wasn't clearly researched at the beginning.

If I could suggest anything to anybody who wants to have this done and make sure they are on the road to approval . . . take ownership of your insurance policy.

You should research the requirements and know them inside and out, make sure that your doctor is in network, make sure you understand all of the preliminary requirements from which they will be making a decision as well. Don't put all your faith in a miscellaneous insurance clerk in an office that may or may not do everything that needs to be done to ensure that you are successful.

[TQUAD64 9]

If I could suggest anything to anybody who wants to have this done and make sure they are on the road to approval . . . take ownership of your insurance policy.

You should research the requirements and know them inside and out, make sure that your doctor is in network, make sure you understand all of the preliminary requirements from which they will be making a decision as well. Don't put all your faith in a miscellaneous insurance clerk in an office that may or may not do everything that needs to be done to ensure that you are successful.

This is great advice Heather!:crying:

[bklyn1984 0]

If anything, you have to be careful with insurance. I also don't think you will have much luck with your appeal so you should get the ball rolling in finding a doctor that is in network and find out if they will credit any previous time/visits towards yoru requirements.

You can't really rely on the doctors offices to verify all aspects of your insurance . . . although they should verify everything from the first visit, if they don't, you are the one who suffers the consequences. However, there are just way too many denials that come from lack of information that wasn't clearly researched at the beginning.

If I could suggest anything to anybody who wants to have this done and make sure they are on the road to approval . . . take ownership of your insurance policy.

You should research the requirements and know them inside and out, make sure that your doctor is in network, make sure you understand all of the preliminary requirements from which they will be making a decision as well. Don't put all your faith in a miscellaneous insurance clerk in an office that may or may not do everything that needs to be done to ensure that you are successful.

Exactly! Great advice. This is what I did. While I was checking my doctor I also checked the hospital, radiology, anesthesia, and lab work. Because I wanted no surprises in the end when it came to bills. Fortunately enough for me everyone was in network. Find another doctor in network like Heather said. It's not worth spending time with an appeal in my opinion. Because even if you were successful your out of pocket with that doctor would be so much more than an in network doctor.

Good Luck :crying:

[ldeere2005 0]

Please check with your insurance company regarding in-network surgeons. They can tell you. I am an insurance biller for a family practice physician and I can tell you that with all the different insurance plans out there, unless your insurance is a "major" insurance company, it is almost impossible for the clinic to know sometimes if they are considered a covered provider. You also need to check with your insurance company regarding if you have any deductible amounts and copays for the surgeon and the hospital. I'm being banded on March 25th and I had a huge fight with my insurance company for almost 2 months before I was able to get my benefits straightened out. And being an insurance biller gave me an edge because I knew what to ask and what to expect. But it was still a fight with them that paid off. The biggest thing to remember is that it is the patient's responsibility to know their policy and which doctors are covered.... that will save you a lot of grief later when the bills start coming in. Besides, if you get a surgeon and hospital that is in network, you'll get a discount because of the contract between the doctor/hospital and the insurance company. Those discounts can add up to thousands of dollars in savings!!!! My best to you!!!!

ldeere2005

looking forward to surgery March 25, 2009!!!!

[DebbieGail 0]

Don't get discouraged. I have two insurance policies, mine from work and my husband's work also carries me. I did the research myself and my doctor sent in the papers also....but to my dismay both came back denied....they both had a rider that even with health concerns they did not cover any bariatric procedures. But I had several things happen 1st My father passed away 2 years ago and my mother 5 years ago...they left me a small amount of Anheseur Busch stock. My mom always wanted to help me financially do something about my weight because a neighbor had the gastric bypass and was successful with it. I was too afraid of something that evasive. Anyway when I got denied - Anheseur Busch was sold...I was not for the buy out - my Dad worked there and he would not have been happy with a buy out. But I was out voted and it was out of my hands...The sale went through and right at the time I found out I was denied the sale went through...My wonderfully supportive husband said it was my money to do with what I wanted... It was a lot of money and I fretted over it...my best friend's husband was talking to me one day when I asked him his opinion of how to invest the money (he is in the finance world and I trust his opinion) He gave me a few ideas and then out of the blue he said you know his wife and told him about my looking into a procedure to help with my weight ... and he said "using the money for that would also be an excellent investment into my future" His wife a few years back had breast cancer and is cancer free at the moment. He values Good Health.

He made me really think hard about that - an Investment in my future! My husband would just say I was the one that had to make the decision and he would support what ever I wanted. My health has in the previous year declined - sleep apnea and my knees and hips were going. I was not very mobile. Shortly after that I made the decision and have never looked back. I know my parents would have been pleased to know they have helped me on this journey.

My advice to you is even since you hit this bump in the road with your insurance ... try again ... you say you lost time ... I don't think you have...you've lost 20 lbs...I realize you have spent some of your own money but that can still be an incentive for you to keep moving ahead toward your goal Think of it as your investment in the future... I believe there was a reason this happened ... maybe to prepare you to succeed ... give you time to be mentally ready, or steer you to the right doctor for you. Sometimes we just have to have faith!

I always tell people I can't tell you if this is right for you all I can tell you is "It's the best decision I ever made for ME!" I am extremely happy with my band and the whole experience.

Of course, it only my 2nd mos. Anniversary was banded 12-11-08. My investment is paying off...even when the stock market is down!

Keep the faith and move forward! Invest in your future!

Highest lifetime weight 386 I started to lose weight to go

to the doctor. I was

ashamed of my weight.

So I worked at it and got

10 lbs. off before my

first visit.

First visit to doctor 376 I was told I would have to

lose 26 lbs before he would

do the surgery.

Day of surgery 343

2nd Month Anniversary is today 314.5

Weight loss since starting this journey 61.5 lbs from my first visit - 71.5 lbs from highest weight! I took a picture today to compare...I actually can see the beginning of a waist...there is a small but visual horizontal v indentation at my waist. But the amazing thing is I'm able to walk 1.5 miles and then immediately bike an additional 10 minutes...Before I had a hard time walking from the parking lot to my work. I have never been happier ... It has so changed my life already!

[coloradobanding 5]

I would be angry with your doctor too!! When I first called my surgeon, they directed me to their billing person, had me fill out a sheet regarding insurance and said they would get back with me once they checked my insurance. Three days later this wonderful lady called me, said they contacted my insurance, told me what they covered, went over the details and asked if I wanted to set an appointment. I did, and got my surgery date. She met with me 2 more times in the next 2 weeks to make sure I knew exactly what was going to happen, which bills would come in first, etc. The day before surgery, I got a call from hospital admissions and they said I was ready to go. I would find a doctor you trust that will help you get the surgery!!!