JustSayMoe

The insurance coordinator at Dr Kim's office told me that the clearance is good for one year. But that's my plan through UHC. My employer (a very large one) has specific rules tied to WLS.

400 with 46 bmi (6' 6" tall). Surgery scheduled in Feb. I hope to be less than 375 on surgery day.

If they are jerking you around go to the state dept of insurance. I made the threat to UHC after they screwed up twice. They promptly approved me after the threat.

Congrats! I just got approval this morning myself. 2/14 is my day.

They blinked and I got an approval. I called them out on their lame excuse for the initial denial and called them out on their failure to meet the 15 day deadline on their end. When I emailed this to the case manager earlier this week, I made the threat of calling the state. I got an approval first thing this morning! My date is in Feb.

Yeah unfortunately my appeal has passed the 15 days response window, my case manager sucks, and I'm getting ready to escalate to management within UHC/Optum healthcare. The case manager refuses to answer her phone and doesn't respond to email or voicemail. Lets hope the management cares more than my RN case manager, or it will be a formal complaint to the TX Dept of Insurance.

A Cadillac plan with Fiat service. The case manager hasn't even called me yet. She'll probably wait for the full 15 days.

I got denied today for the lamest reason. They took almost 15 days to tell me that 2 months of my supervised diet weren't valid, since the technically didn't fall within their 2 year limit. The problem is I've met my deductible so these guys are effectively going to stall me off until 2013. Then I have to pay more. So we have to send them information from 2 other doctor visits. Then wait 15 more days, which will make a 2012 surgery impossible. So what's the out of pocket typically for VSG? I have a Cadillac plan.

After trying to speak to my case manager at Optum health on multiple phone call attempts, I finally gave up an emailed her. She told me that the determination staff have 15 days to decide from when the paperwork was submitted. Looks like Halloween at the latest. It's a shame that they screen their calls. I called about ten times and didn't get an answer. The doc operates on Thursdays, so I have six potential dates if it comes on 10/31.

All of my paperwork was sent into UHC on Tuesday last week. I've done all of the requirements. I have a 46 bmi, diabetes, high blood pressure, and cholesterol. I figured it would be a quick approval. Nothing but crickets. I'm really hoping to have surgery this year, but time is slipping away. Is this common? I'm calling the case manager Monday to see what's up.

I got diagnosed with severe case of apnea. I got the CPAP and absolutely love it. I feel like a million bucks after sleeping with the machine. Plus another great side benefit is I can fart all I want and not smell it with the mask on. 8-) I told my wife that when I got home with the machine and rolled her eyes.

Same here. Summar is really on top of things.

Thanks for all of the responses. My gut (pun intended) said Kim. You guys reaffirmed my choice.

Nicholson has unofficially been written off. I should submitted to the insurance for approval with Dr Kim today. Wish me luck.

My Baylor options are Plano and Carrollton. Both are close, but not Kim's hospitals.

I'm an engineer and am very, very risk aversive. Just like you, I can't make mistakes when the situation calls for perfection. The lackadaisical approach certain people take really makes me mad.

Yeah. My UHC insurance requires a center of excellence rating (marketing spin for pre-negotiatied cheapest rates possible). If I go with Nicholson, I go to Presbyterian. If I go with Kim, I must go to Wise. I can also pick Baylor, UT SW, Plaza Medical center in FW, or Medical City Dallas hospital. Btw, shortly after this post the folks from Nicholson called me two or three times. It's almost like their ears were burning! :-)

Yeah. I've called them a little bit ago. I'm BMI of 47 (6'6" & 400 lbs.), plus diabetes, plus high blood pressure, plus high cholesterol. I did a medically supervised 6 month diet a year ago(required by UHC). I've told it should still be good. If that's good, I should be looking at an approval soon. The complication rate of Dr Kim sold me initially.

This is my first post. I've been lurking for a while now. I'm Michael and I live in the DFW metroplex. I initially saw Dr. Kim in Colleyville. I was impressed by his staff and record, but not so much the Dr himself. I would also have to go to Wise medical center for surgery. I wasn't to happy about that either. I could overlook a dry personality, but not a hospital 90 minutes out. Dr. Nicholson seemed like the next logical choice. He's in Plano and I'm in Plano. No strange far away hospital, and he seems like a great Dr. I have serious doubts about his staff's competence. They've made multiple mistakes and were clueless about my insurance requirements. They don't seem to run like a well oiled machine like Kim's staff. I'm in the fence. Do I go with Kim and Wise or tolerate the mistakes from Nicholson and go local? Has anyone had surgery at Wise?