Sumaire

I do use my fitness pal. I have for about a year now. And Protein Shakes actually aren't recommended much in my program. Powder yes. But shakes no. I also get started on clear purees the day of, and regular purees by day three. It's weird. But the best, nationally known Bariatric hospital around me. I have confidence in it. Sent from my iPhone using the BariatricPal App My surgeon recommends shakes like Premier Protein. They have the protein, but are artificially sweetened, so each shake has a whopping 1g of sugar.

Got their letter today denying my surgery, saying that my current surgeon doesn't do surgeries at the hospital to which I am "capitated" (gawd, but I loathe that word). Funny, but they've been approving my monthly visits to my surgeon since last August, a surgeon THEY assigned me to when this whole thing first started in earnest. Now they're saying No, because he doesn't practice at a specific hospital. They sent me a referral to a DIFFERENT surgeon, and lo and behold, when I told the lady on the phone at that office what the denial letter said, she told me that this new surgeon doesn't practice at that hospital, either. WHAT THE HELL ARE THESE JACKASSES TRYING TO PULL???? This is <insert really nasty expletive here> and I'm tired of the games. They've picked the wrong ridiculously fat lady to screw with, and I've got a call in to Anthem Blue Cross' appeals department about this. I also mentioned to the nice lady at ABC that Preferred IPA had denied every surgery request for other patients that my preferred (see what I did there?) surgeon has sent them since this last January. The lady at ABC was nonplussed when she heard what's been going on. We'll see what happens, but I'm more than a little hot under the collar about all of this mess. Thanks for listening.

I would hope that the insurance company she works for actually knows what surgeons are connected to what hospitals, or even if that hospital offers bariatric surgery in the first place. My former provider apparently had no clue. Meanwhile, they were the ones who kept insisting that I go to a hospital that did not offer it. Sent from my iPhone using the BariatricPal App

I can't until my first appointment on July 1st with my new PCP. I'll be right there, asking for my referral to the surgeon I've chosen. Two weeks from tomorrow. ​I'm hoping it's not like when I was a kid, waiting for the next school holiday to arrive. LOL

Thanks. I hear he's remarkably tall. It's a Center of Excellence, right? I've recently changed providers and PCPs just so I could get the surgery. My old provider was apparently insane. They picked the wrong fat lady to screw with. Sent from my iPhone using the BariatricPal App

After several twists and turns, I've chosen Dr Lamar for my surgery. Did you end up having yours with him? Sent from my iPhone using the BariatricPal App

I'm having to change providers, and thus my PCP, in order to even HAVE surgery. Has anyone here used Dr Troy Lamar for their surgery? I chose a particular PCP because he and Lamar both are in the same network. It was pretty bass ackward, because I chose the surgeon based on his taking my plan, and then chose my PCP from a list of doctors who are also on it. (I can't help but think of the Simpsons character Troy McClure when I think of or say his name. Is that bad?) FWIW, If you have Preferred IPA for your provider and you're still waiting on approval, make sure your capitated hospital even offers Bariatric surgery. My former capitated hospital does not, although PIPA kept insisting I find a surgeon who performed it there Sent from my iPhone using the BariatricPal App

?????? Sent from my iPad using the BariatricPal App I'm assuming that the poster feels that only people who have insurance OTHER than state-paid should have their bariatric surgery covered. I disagree with that opinion.

Well, it's resolved for now. I've changed providers and thus doctors, aftering find a surgeon who accepts my insurance and then finding a doctor who is affiliated with the same insurance provider. It turns out that Monterey Park Hospital doesn't even support bariatric surgery, so Preferred IPA was making a requirement that could never be fulfilled in order for me to get surgery. I'll be making a formal complaint about that, as I can't be the only person who has been affected by this deliberate stonewalling. Hoping for a fruitful relationship with my new insurance provider.

Preferred IPA are the ones sending me to surgeons who don't do surgeries at the hospital they say I am capitated to. As far as I can tell, there are no doctors who accept my insurance who also have privileges at Monterey Park Hospital. Sent from my iPhone using the BariatricPal App

Oh, this gets juicier. I made some phone calls today. The insurance company (Anthem Blue Cross) says I'm capitated to one hospital, while the approving people (Preferred IPA) say I'm capitated to another. I called both hospitals, who told me that they're part of the same system, but NOT the same hospital. But this is where it gets even more interesting... The one my insurance company says I'm capitated to does NOT do bariatric surgery, and one the approving body says I'm capitated to DOES do it, but I was unable to find any doctors who both practice there AND take my particular insurance. I may have found my way to demand a variance and get my surgery with the surgeon I want. Preferred IPA may enjoy watching me run around in circles, but again, they've picked the wrong fat lady to f around with. I don't take "no" for an answer. Sent from my iPhone using the BariatricPal App

Gets better. There are no doctors who practice at Monterey Park Hospital (where Preferred IPA says I'm capitated) who accept Anthem Blue Cross. You'd think the insurance company would know that already. Meanwhile, Anthem Blue Cross says I'm capitated to Alhambra Hospital, which doesn't DO bariatric surgery. Sent from my iPhone using the BariatricPal App

Oh, I'm sure it's all about trying to get people to give up. I'm a stubborn fat lady, though. They've picked the wrong evil old lady to mess with. Sent from my iPhone using the BariatricPal App

I need one that does surgery at Monterey Park Hospital and has a deal with Preferred IPA. Sent from my iPhone using the BariatricPal App

I'm sitting on my arse and waiting for my insurance to send me to a surgeon who they will actually cover for the surgery. So far, I'm zero for two on that bet. Sent from my iPhone using the BariatricPal App

The insurance company's response to the doctor's staff about this was that it wasn't the company job to send me to a doctor who had privileges at the hospital to which I am capitated. THEY sent me this particular doctor. Not my GP. Sent from my iPhone using the BariatricPal App

My kid isn't happy at all that I'm planning to have the surgery, but I'm not going to let her talk me out of it. Mainly, she's worried that I might die as a result. Trust me, I wouldn't be doing this if I thought there was something I had to worry about. I hope things go well at work for you.

And at this point, my GP's office is submitting a modified request specifying that the surgeon chosen actually has privileges at the hospital to which I am capitated.

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You don't have high blood pressure, sleep apnea, or degenerative arthritis in your spine/hips/knees (dumping the weight can help to slow that down)? Just a thought...

Called my doctor's office a couple minutes ago. "Your ears must have been burning, we were just talking about you." Seems that Preferred IPA gave them a call this morning to tell them that they are working on a LOA (whatever that is) right now. I guess my phone calls must be having an effect on things.

My doctor is in Beverly Hills, so I'll be hitting the hospital closer to him. I'm not sure right now which one that will be. The issue I see in my near future, is that my insurance company is being a complete d*** about approvals. Sent from my iPhone using the BariatricPal App

Spoke with ABS and LACare (who I have my insurance through, ultimately), and they have said that the two year requirement is bogus (not their words -- I'm paraphrasing). They are having me have my surgeon's office submit a request and if/when it's denied, promptly filing a grievance to get this resolved. Weird (but nice) when the insurance folks are actually TRYING to help you.

They seem to be going with the second example given, rather than the first one. Leave to them to be far more restrictive. • The recipient has failed to sustain weight loss on conservative regimens. Examples of appropriate documentation of failure of conservative regimens include but are not limited to: Severe obesity has persisted for at least five years despite a structured physician-supervised weight-loss program with or without an exercise program for a minimum of six months. Serial-charted documentation that a two-year managed weight-loss program including dietary control has been ineffective in achieving a medically significant weight loss.

I will, thanks. It's just frustrating, as I'm not a patient person. Sent from my iPhone using the BariatricPal App