former_vbg

Fortunately, called Aetna and it was re-approved at 1:53pm this afternoon. I find it ironic that I know before my Dr. office. I don't get it though. The first time this was approved- that Dr. office knew the same day. This new Dr.'s office outsources to this one lady who does a lot of things @ss backwards. My new Dr.'s office won't let me schedule a surgery date until this lady they outsourced to do the insurance "tells" them it's approved. My first call in the morning will be to this lady who submitted the insurance request. I'd like to get a surgery date set tomorrow.

Just found out that at 1:54pm my re-certification was approved. I hate that this Dr. outsources the person who does the insurance approvals. Why am I finding out first.... ???? Hoping to get a surgery date set tomorrow for the next couple of weeks. Hopefully no more surprises.... am so tired of all these hoops!!!

Wow, that had to be a shocker. I would have thought that surgeon would have stopped taking new cases if he wasn't going to be doing surgery at that facility. Glad it worked out for you. I don't care for the woman they have doing the insurance submissions. They outsource it to some obnoxious lady who when I called to talk to her had all kinds of things wrong about what Aetna's policies were.... Then, she refused to even submit a "dummy" surgery date which helps expedite the process. Grrrrr I'm going on day #4 now...

I posted this in the Insurance forum too, but thought I might get more input by posting here too. I was full steam ahead with a surgeon in Dallas, did all the hoops, had a surgery date set and then found out they are engaged in insurance fraud. So needless to say the brakes went on fast and hard.... I am now going through another surgeon and having to get re-approved through Aetna. They haven't changed their policy bulletin, and waiting for them to re-approve it. This Dr. is in network and such, so I would think it should be just a formality, but still worried I guess. Anyone have to get re-approved? Had any problems? Anyone who could share their experiences or people they know would be greatly appreciated. Aetna has had my information since Monday and waiting...... Waiting once was hard enough...

It is expensive to run a hospital, but those fees are absolutely criminal IMO. I learned awhile back when I used to work for a larger hospital that the reason EVERY healthcare provider charges / BILLS for more than they know they will be paid is then it allows them to use it as a write off at the end of the year by Uncle Sam. Hmmmm, makes me wish I could do stuff like that and reap those kind of tax benefits.

I was full steam ahead with a surgeon in Dallas, did all the hoops, had a surgery date set and then found out they are engaged in insurance fraud. So needless to say the brakes went on fast and hard.... I am now going through another surgeon and having to get re-approved through Aetna. They haven't changed their policy bulletin, and waiting for them to re-approve it. This Dr. is in network and such, so I would think it should be just a formality, but still worried I guess. Anyone have to get re-approved? Had any problems? Anyone who could share their experiences or people they know would be greatly appreciated. Aetna has had my information since Monday and waiting......

I'm sorry, I wasn't trying to do that- please accept my apologies. I have wasted 3 months with that office and just very frustrated. As for them getting paid more money for a revision? It is very nominal, probably only $500 to $1,000. They were trying to get me to pay $2,000 and then they went up to $2,500.

Thanks for the information. The reason is Because I TRUSTED the last surgeon's office to do the right thing by requesting the correct CPT code. I didn't pay attention to the specific language of the approval letter from my insurance because the surgeon's office was satisfied and I just put it in the file. I now find out they only requested just a virgin sleeve and NOT the revision, and then at the 11th hour after I was already scheduled for surgery tried to tell me I needed to come up with additional fees to do the surgery because a revision would take more time. I told them they would need to take that up with Aetna. They couldn't even give me an amount and after two days I called back to get some answers since I was in the process of filing STD at work, re-arranging my entire life at home to be out of the state for a whole week and then they drop that bomb on me. So, after 2 days when they couldn't give me an answer, I asked them how much they have charged past patients and the lady said $2,000. I asked her about the written documentation I had from another individual from their office that I had specifically stating there were NO additional fees besides my co-pays and out of pocket maximums. Then, the next morning when I called to talk to the office manager she went up to $2,500 and refused to honor the written documentation I had from their office saying it was just a mistake. Mind you, this written documentation is from February. This office wasted THREE MONTHS of my time- so it matters to me financially VERY much. Aetna has since gotten involved because they are in violation of their contract by trying to bill patients for procedures they are supposed to be billing Aetna PER their contract. Back to my original comment- they FAILED to request the CPT code for a revision and thought they could just siphen the extra money from me up front- that I must be some dumb hick and won't know better. Yes, I'm a bit heated about the whole thing. Anyone in my shoes would be too. Since I have to go through the whole pre-certification process (PER AETNA), I want to be sure this time when I get my pre-certification letter that they have submitted for the correct CPT codes. By them not submitting the correct CPT codes, it made me only eligible for 1 night stay as well- had they submitted for a revision, it would have been I believe at least 2 days, maybe 3- but more than 1. Make sense? Also, to answer your question, it would be laproscopic.

I found out a few days the surgeon I was supposed to be having surgery with next week has been less than honest on submitting for my pre-certification. They didn't even submit for the revision itself, just the sleeve. It's a really long story and still unraveling actually. Aetna has gotten involved and I believe that surgeon's office is now being investigated for violating their contract. Anyways, I could really use some help with anyone who has access to CPT codes. I am changing surgeons obviously, but now that I am a bit wiser on what to watch on the pre-certification process, I was hoping someone could look up what the code is for a bariatric revision. I don't know if it is broken down based on say a lapband to a sleeve or in my case a vbg to the sleeve. I do know that the revisions are bundled and paid as such, which is one of the reasons this surgeon's office tried to pull a fast one. Never in my life has I experienced such outright deception in something like this. The kicker is, Aetna has them on a recorded line admitting they were doing this- but not realizing it until it was too late. Aetna really stepped up to the plate for me on this one. So, please anyone that might be able to help me on this- I would really appreciate it. PM me if you prefer. Thanks. p.s. I didn't post this in the insurance section because I didn't think it would get as much attention there.

Oh my yes, and thank you! I don't aim to look like a stick, just healthy and not ashamed to wear shorts and cute clothes that might actually accentuate my body instead of trying to cover it up.

I don't think anybody on here who talks about them puking EVER does it by choice. When that feeling hits, it literally feels like it is going to catapult right out of your mouth at any moment if you don't just let it happen. I haven't had the sleeve yet, but I had the VBG 13 years ago and I've dealt w/that puking thing for years. So, I know all too well what that is like. To this day, there are still foods I cannot eat. meat that isn't cooked well is an absolute NO GO. Some vegetables (particularly raw) are a NO GO either. Don't let this scare you though Kelly. It's really not that bad, but I understand everyone has their phobias. Mine is swallowing pills and shots. I'm sure you have been reading up from other people's experiences so you will be even MORE in tune as to what to do and what to NOT do. Good luck, you will be fine!

I like the term, "clothes horse". For the exact same reasons, I have sizes of clothes from 6/8 up through 22. In fact, I have so many clothes that I had to make make shift closets in the basement. I have two strings of clothes, one which is probably 8 ft long and the other is 5 ft long. Not all are necessarily office wear, but I'm kind of cheap too. I just like to consider myself thrifty in that I hate having to re-buy things over and over. I'm getting better at getting rid of stuff, but have held off on the clothes thing until after I have my surgery- which I hope to be in 3 weeks (pending results of a pre-op procedure this Wed). Great story though!!

I did the consult, an MMPI and two short tests. The one short test I think was something like word association, some memory and I can't remember what else. What do those tests show? I know that might be a tough question to answer without more information, but just curious if you had any ideas. Like, I was given 3 different words at the start of one the tests and then told I would be asked what they were at the end. Even though it was a short test, I have a horrible memory on stuff like that. He said sunset, and 2 other words. I spent the whole rest of the time after he gave me those words saying them in my head, not really able to pay attention to the other questions.

Thanks, I will keep this in mind for Wednesday if things don't go as I hope and suggest it to the GI Dr. Was it a pill or dissolvable tablet?

I'll share that at my lowest weight of about 162, and being 5'4" I was pretty easily wearing size 9/10. Also remember not only our bodies are built differently, but different manufactures can vary greatly. There is the 9/10 petite, relaxed fit, long, etc... All those can really make a difference.

Be patient. I have Aetna also, and although mine was approved in just a tad under 3 days, I was sure to "bury" them with documentation. You can call their customer service to find out the status and they will tell you. I actually called myself to do that and actually found out 3 hours before my surgeon's office that I was approved because they hadn't sent them the approval yet (was in process). You can imagine how excited I was. Do call them, be polite and just ask them if they see any notes in the file like missing documentation or something. I was also told that the closer it gets to summer the longer it can take because more people are taking vacation which equals a shorter amount of staff to process the pre-certs. Good luck!

My "doc" told me 2 1/2 hrs too, but honestly I was there maybe about an hr and 15 minutes total. He and I knew some common professional people and so because of that affiliation, I sort of had an automatic "pass". He did talk a bit about my past, history with food, expectations of the surgery, etc... Then, took 3 different tests including the MMPI. I do career counseling on the side and so I know all these tests quite well, it took me maybe 20 minutes to get through all the questions for the MMPI, and the other 2 tests were bubble type taking maybe 5 minutes each. No biggie. One thing to keep in mind is that when the shrink can submit documentation in the form of tests taken, it can do nothing but help substantiate the person's mental readiness for the surgery when being presented to the insurance company.

I called my PCP earlier this week and he said Flovent wouldn't do anything for my condition, that I had a different issue with my Esophogus- so he said just to keep taking the PPI's. So, I have.

Well, I have had an unexpected set of events this week. I finally broke through the "office" barrier and got to speak to the surgeon Monday about the issues he has with my Esophogitus. When I explained to him that my symptoms stopped within 24 hrs of starting the PPI treatment, he was surprised but happy to hear this. I explained that I have another EGD scheduled for 5/4/11, but that I was concerned with the amount of time it could take for it to completely heal. He didn't think it would take as long as I had been told. Nonetheless, he said that if I showed improvement at the next EGD that he was willing to go ahead with my surgery. THANK GOD!!! So, next Wednesday I will have my EGD- praying for positive results. So, then I called their office today to talk about possible surgery dates so I could start planning things at home. Come to find out the surgeon is going on vacation the first part of June and since I will be traveling out of state, and need to see him a week after the surgery before going home, I can't have the surgery just before he goes on vacation in case there is a problem (error on the side of caution). Sooooo.... EGD 5/4/11, hope I get my results back within a couple of days because on 5/10, I am scheduled to get my EKG and bloodwork done. If that all goes fine (it should), then 5/12/11 I will start the liquid diet, go down to see the surgeon on 5/18/11 and surgery 5/19/11. All this is resting on on the results of the EGD!!! Say a prayer for me!

Thanks for the post, those are good tips. As far as how the date acts in response to the WLS, ideally, we should be able to tell them in the beginning. I think given the overall negativity among the general public due to lack of education and mis-information, and so the idea of telling a new date can be a bit intimidating. I do think its important they be told- for many reasons, but the biggest reason because you need their support in managing your new eating habits/ lifestyle. It's not very often to hear of someone who has had an RNY, and then has a Sleeve. I am just curious who your surgeon is.

Have you been approved already? I'm just surprised you will be able to set a date if you don't have your approval by then- but maybe you will.

That is a bit scary. Just did a google search on that and it said: Esophageal thrush, also called Candida esophagitis, is a fungal infection of the esophagus. This infection characteristically occurs in people with a weakened immune system, including persons with leukemia or lymphoma, those receiving chemotherapy or immunosuppressive drugs, and people infected with HIV. http://www.livestrong.com/article/124290-esophageal-thrush-symptoms/ Read more: http://www.livestrong.com/article/124290-esophageal-thrush-symptoms/#ixzz1KJ9eMrbN I guess I will discuss it with my Dr. and see what he says, but boy it would be great if this would resolve the issue for me to have my surgery. I could then go back to the PPI if needed to maintain the healing.

Not only a great next chapter, but a healthier one with more mobility, less meds and better quality of life!!! Why NOT at 60 I would ask...

Thanks, no, they have me on something called Lansprazole. It's a delayed release orally disintegrating tablet. It worked almost from the first day at controlling the acid reflux. I have another EGD scheduled for May 4th. I'm wishing though I could go out and get this inhaler type of steroid now based on what I am reading of how quickly it can heal things. Going to be calling Monday and see if I can get my PCP to get me a prescription for this.

Just curious, has anyone ever used Fluticasone propionate (Flovent)? I was reading up on the use of steroidal treatments for Esophogitus and this looks quite promising. Just curious if anyone has ever used this treatment. Here are a couple of links that describe it more. http://www.medicinenet.com/eosinophilic_esophagitis/page4.htm http://www.eosinophilicesophagitishome.org/treatment/EE-treatment-swallowed-inhaled-steroids.shtml