What should I do? Need your advise

dovie6523 · April 20, 2006

Hey everyone... I need some advise. I am working on getting approval from my insurance for the surgery. I am currently doing the "required 6 month weightloss program that my insurance is requiring me to do. It was the only thing standing in the way of the approval (We will see:rolleyes: ) Anyway, this is the delima... My surgeon (who is in my ins PPO network) does his surgerys at USMD Hospital here in Arlington. He also does them at the "Speciality Surgery Center in Ft. Worth. Neither of these two locations are in my PPO network. I called the insurance coor. for Dr. Carter office and she said I should just wait until I am approved to worry about it. Well if I wait until July and found out that Dr. Carter can't do my surgery, I'm back to square one again and have to start over with another doctor. I guess I am looking for some insight from y'all as to what I should do now before july. I have been working and waiting since November. I am so close now, I don't want to have to wait again. What should I do?

Elisabethsew · April 20, 2006

I would get a list of all the MDs who perform lapband surgery in hospitals that your insurance company DOES cover and check them out. Ask your present MD to give you copies of all the reports in your chart. The requirements for the surgery are pretty universal so whatever you've had done already will, for the most part, be accepted by the new surgeon you choose. To put it simply, use the waiting time to develop a "plan B" in the event "plan A" falls through.

dovie6523 · April 20, 2006

I have been trying to work on that, however alot of the doctors that do WLS in my area, work strictly with a WLS surg. center or a specific hospital and that makes it hard to find a doctor and the hospital that are BOTH in the PPO Network. Thank you for the advise. I guess I just needed to hear someone tell me I wouldn't have to start over. Thanks again!

DonnaB · April 20, 2006

DON'T WAIT! Your insurance company is in business to MAKE MONEY. If they have any reason to deny your surgery they will. Sorry to be so negative but don't wait. You WILL have to start over and they're hoping you'll get frustrated and give up. Don't you do it!

Best wishes for your insurance approval and surgery.

dovie6523 · April 20, 2006

Thanks Donna.... I am not giving up.. That is for sure! Yes, the insurance companies make it so damn frustrating!!!!!! Thank you for your input! I appericate your reply.

Mvpo8961 · April 20, 2006

Dovie Dr. Richard Carter has priviliges at Medical Center of Arlington. There is no reason why he can't do it there. He may prefer the other places but he can do it at MCA. I would assume that would be in your approved network since it is the big hospital in Arlington. I know my surgeon in Dallas prefers SCOR in Richardson but my insurance requires a HCA facility so I am having it done at the hospital. The benefit is I can go any day he does surgery at the hospital rather than the Wednesday which is the day he goes to SCOR. M

dovie6523 · April 21, 2006

Hey thanks... I will call Dr.Carters office again. I am somewhat frustrated with the Insurance Coor at his office. I just can't seem to get straight answers from her. I don't know how many times that I told her that USMD and the center in FT. Worth were not in my PPO and ASKED what I needed to do. Wouldn't you think they would be a little more interested in getting my services and isn't all this research HER job? I just hope that this is not the way my followup services will be like. I am almost to the point of going somewhere else. I just am venting... Sorry! Thank you for your reply.

dovie6523 · April 21, 2006

Yes! I will keep squeaking! Thanks for the info. Good luck with your upcoming surgery. I am hoping everything will go well and I will be behind you in line. Always looking ahead..

shackdog · April 21, 2006

hang in there dont give up

dovie6523 · April 21, 2006

Thanks! It's so nice to have the support! I think everyone gets sick of listening to me:bored . It's a comfort to be able to come and talk to you all! Thanks again!

jewels411 · April 27, 2006

hey anyone out there from san antonio who got there lap band from dr. rincon @the wish center or dr. rumbaut in monterrey? dont know which dr. to pick need help