Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

Just wanting to vent. I've been on this Journey since last January with my first MD appointment on 2/7/14. We discussed surgery in May and the MD said that was doable. I was told that all I needed to do to get my surgery was the Psych eval, EGD, and one pre surgery class.

I got my Psych eval done in mid March 2014, and waited to hear from the MD office. In early April, I started emailing and calling the office and didn't hear back. I've been an RN myself for 18 years, and just couldn't believe that I was being ignored. My the end of April, I had given up on my May surgery date as I had never spoken to anyone from the surgeons office since my appointment in early Feb.

Out of the blue, in June, I received a phone call from a nurse in the office that stated that she was new, and saw my emails and voicemails, and didn't see where anyone had gotten back to me. She was nice and apologized, and stated that they had had major turmoil in the office with almost all the staff leaving. I got lost in the shuffle, she was apologetic, and sympathetic to my voicing my frustration and anger. She stated that she would talk to the insurance 'people' and have them call me with the next steps.

I never heard from anyone again. In late July, I called again, and left a voicemail stating that I would really like to schedule my EGD and finally move forward. I was actually called back within 2 days, and scheduled the EGD for the 9/2/14, and my class on 9/8/14.

On the morning of the 8th, I call and talk to my patient care coordinator that was just put into her position 2 weeks ago. I ask her if there is anything else I need to do because by the information that I was given in Feb, I was ready to be submitted to insurance for approval. She comes back and tells me that I have to do a 4 month supervised diet now.

I am so discouraged. I am so ready to have this surgery, and I've gotten nothing but the run around from this office. I can't afford to pay for it out of pocket and it's the only place that our insurance covers. (My husband is an RN at the same hospital.) So, while I've sat around for months waiting for the office to call me back, I could have been dieting but they neglected to tell me that my insurance had this new requirement. Ugh.

So, now I'm hoping to have surgery in late Dec/early Jan. Anyway, thanks for listening. My journey continues.

Any tips for the diet? What if I lose too much? We'll see what my PCP says about it next week.

Share this post


Link to post
Share on other sites

Switch surgeons

Share this post


Link to post
Share on other sites

I'd change an call my insurance they can help on surgeon. That is a mess!

Share this post


Link to post
Share on other sites

I can feel your frustration. So sorry they are giving you the run-a-round. =(

Share this post


Link to post
Share on other sites

I go somewhere else... At least that's what I would have done. On the other hand you might lose more time. I understand your frustration.

Share this post


Link to post
Share on other sites

I would definitely file a complaint thru your insurance company.

Share this post


Link to post
Share on other sites

Yeah. I wish I had the money to just go where I want, but I don't. I am going to file a complaint with the health care company, but at this point just need to jump through their hoops. I've gotten this far and don't want to start over and pay out of pocket. It sounds like many of you have more than one option. I wish I did. Filling a complaint is my only recourse at this time. Thanks for your thoughts.

Share this post


Link to post
Share on other sites

Good luck and keep us posted.

Share this post


Link to post
Share on other sites

Since I have several long-term medical conditions, my insurance company assigns a case manager for me. That way, when something flares up or I need surgery (like with my knee replacements), the case manager gets involved. Since it is in their best interest, too, for things to proceed smoothly and quickly, I get support from their end when my medical providers cause a glitch. She makes calls for me to get providers off their a** and informs me of what I need to do to meet their requirements. She has called me to find out if my physical therapist is doing their job and how thay are treating me and do they keep their appointments with me, etc. etc.

Does your insurance provide anybody like that who can help you? The medically supervised diet is not so bad. You will learn how to have a more heathy relationship with food and gain new skills for successful maintenance for the rest of your life. I am so sorry that you have had so many struggles with this process. Just remember that delay is not denial. Hang in there and don't take NO for an answer. I wish you good luck and good health. (I just typed "good lick and good health!") LOL :rolleyes:

Share this post


Link to post
Share on other sites

You need a different surgeon. If they are that uncaring and that unorganized preop they are going to be just as bad if not worse postop when you really need them!

Share this post


Link to post
Share on other sites

I'm sorry you're not in a position to go anywhere else. I had similar trouble at the hospital where I first planned to go (I don't even know who my surgeon would have been because I met someone new every single time I went there), so after I finally FINALLY got approval, I switched hospitals. Luckily my insurer didn't care as long as the hospital had the same level of certification, which wasn't hard since I live in a big city.

Are you sure there aren't any other places your insurer would cover?

Share this post


Link to post
Share on other sites

Since I have several long-term medical conditions, my insurance company assigns a case manager for me. That way, when something flares up or I need surgery (like with my knee replacements), the case manager gets involved. Since it is in their best interest, too, for things to proceed smoothly and quickly, I get support from their end when my medical providers cause a glitch. She makes calls for me to get providers off their a** and informs me of what I need to do to meet their requirements. She has called me to find out if my physical therapist is doing their job and how thay are treating me and do they keep their appointments with me, etc. etc.

Does your insurance provide anybody like that who can help you? The medically supervised diet is not so bad. You will learn how to have a more heathy relationship with food and gain new skills for successful maintenance for the rest of your life. I am so sorry that you have had so many struggles with this process. Just remember that delay is not denial. Hang in there and don't take NO for an answer. I wish you good luck and good health. (I just typed "good lick and good health!") LOL :rolleyes:

I've talked to my insurance a couple of times. The issue is that they had the wrong info at the start of the year. They changed from a 6 month diet to a 4 month diet, but their system erroneously dropped the requirement completely. Then my doctor's office failed to communicate that to me due to the staff turnover. They do not have a case manager for me. I'm still figuring out my options. I am going to call them next week to see how to file a complaint.

That is awesome for you though to have someone watching over both of your interests.

I'm sorry you're not in a position to go anywhere else. I had similar trouble at the hospital where I first planned to go (I don't even know who my surgeon would have been because I met someone new every single time I went there), so after I finally FINALLY got approval, I switched hospitals. Luckily my insurer didn't care as long as the hospital had the same level of certification, which wasn't hard since I live in a big city.

Are you sure there aren't any other places your insurer would cover?

I am sure. My husband and I have both been in this field for 2 decades. It is somewhat common for hospitals to insure themselves or only fully cover themselves. They will pay for out of network procedures for most things but not bariatric. I have to use their own services if I want any coverage at all.

I guess I didn't expect so many to have such flexibility on their coverage that so many of you can and do suggest to start over. That is eye opening. I can only work within my options though. Thanks to those that offered their support.

I will be ok, I'm concerned about the diet part, but agree that it will be good to get my head back in the game so to speak. My insurance sent me their guidelines and I have to show the inability to lose greater than 2 bmi points to qualify. I don't think I could do that if I tried in only 4 visits. My current bmi is so high. Hopefully this is the final hurdle though. Now, no more just switch your surgeon talk. I can't do it. I can give up completely, but I refuse to do that! I'm down but not out.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • vsg.with.sharon

      Hey everyone!
      I’m new here! Looking for some friends! 🥰
      · 0 replies
      1. This update has no replies.
    • LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×