Hi all. I'm brand new to this forum and have been so impressed with all of your weight loss successes and friendly advice. I was hoping you could help me with an insurance saga I've just uncovered.

Long story short, but I've been working w/ UHC for the past several months to have mine & my husband's lap band procedures approved. We've jumped through ever hoop, and thought we were ready to submit for final surgery dates/approval/etc. So today, after spending 2.5 hours on the phone w/ UHC and getting the nastiest most unhelpful people imaginable, I finally got to a helpful person who told me that - oops - you need a 6 month physician supervised diet program.

Now this wouldn't be a huge deal had they told me several months ago when I first started this journey - I'd be almost done by now! However, now I'm back to the starting board.

I have a family member who is a physician and is willing to help us supervise our diets and go back a few months as he's been involved in the whole process, knows weights, etc. This is great but he hasn't done a medically supervised diet before.

What I need your help on is this...

Do any of you have a letter or progress notes that you'd be willing to share so that he can use a similar format? I just need to give him the basic idea of what he needs to write, what he needs to notate, etc.

I would greatly appreciate it! If you could PM me, I could send you my email address. I have a fax as well. I am totally desperate and could not thank you enough.

Thanks everyone in advance!

Stefanie

I just think that it would be more affective and SEEM less shady if you disclosed up front that you work for doctors. call your job title what you want, but unless people know how things work on here they might not realize it. your intentions might be well intended. But dont you think it would be less likely to be perceived as sketchy if you just disclosed your job and get it over with ? There are so many people on here that ARE sketchy it makes it hard to weed out the good intended people from those who are not .

Mindy

Ok, I must be missing something here. I see that there are a few people who are mad at lpbndinfo and can't for the life of me figure out why. Did she hurt someone or is it just the need to know? I give advice to people on a few of the boards and quite frankly they don't know who I am. Does this really distress people that much?

I thought we were all here to help each other on our journeys no matter who we were. So what if she knows/works for some doctors in the field. Maybe they're ok. I think it's up to the people getting the band to check out the doctor of choice regardless of what someone on this board says. I mean, I've heard good and bad about lots of doctors.

I know that there are a lot of people I know that would be grateful for any information that they received about how to get the band. How many people have gone to doctors for all sorts of reason knowing that they weren't the best but because they had no other choice. I sure would like to know what set this off.

Oh yeah, I use my office email also because it's the one I check the most.

Mindy,

I appreciate your thoughts and suggestions... but I perfer to help folks individually for many reasons... one up front would be... Everyone has an opinion on the best recommended choice.. and I am not interested in competing to share what I hae either learned or experienced... if a patient or person asks me what I do for a living then I am fine with telling them. BEcause of my associations and jobs I feel that it might appear that I am trying to convince or act as an authority on a certain given subject. When I talk with someone I want it to be with the most true and accurate info that I have found... I also wont slam doctors or hospitals anywhere in the world... I was taught as a young girl that...

1. If you dont havesomething nice to say, say nothing....

2. If I slam someone else, it says more about me then the place I am slamming....

So, all these postings have been really interesting... It just seems to be a real hornets nest. I didnt come on here for at least the first 3-4 years that I have been working in this field because I didnt want folks to be confused who I am... Or be accused of what you are suggesting.

I now work very hard and when I have a few minues, I dont mind coming out and helping others.... Sorry if it comes across (to you and wassabubblebutt) that I am not saying who I am... but that isnt really true.... I want to come across as a bariatric success and share that... when and with whom I choose. I read posts quite often.... some just touch my heart to the point that I feel that I may be able to encourage or steer them into a better direction (not a better doctor)....

As always best wishes...

Ok, I must be missing something here. I see that there are a few people who are mad at lpbndinfo and can't for the life of me figure out why. Did she hurt someone or is it just the need to know? I give advice to people on a few of the boards and quite frankly they don't know who I am. Does this really distress people that much?

I thought we were all here to help each other on our journeys no matter who we were. So what if she knows/works for some doctors in the field. Maybe they're ok. I think it's up to the people getting the band to check out the doctor of choice regardless of what someone on this board says. I mean, I've heard good and bad about lots of doctors.

I know that there are a lot of people I know that would be grateful for any information that they received about how to get the band. How many people have gone to doctors for all sorts of reason knowing that they weren't the best but because they had no other choice. I sure would like to know what set this off.

oh yeah, I use my office email also because it's the one I check the most.

Vicki are you a patient coordinator for a baratric surgeon ?

Wow !!! Thank you Vickie...

I feel like I am knocking my head against the wall here. You put it perfectly... I had made few post replies and it just went out the door.... I really would rather spend my time helping someone then defending who I am and that I am ethical and have integrity.... Hope to here from you anytime... You can email me personally at bandinfo@verizon.net

Take care and hoep you have a great 2008

Mindy,

I appreciate your thoughts and suggestions... but I perfer to help folks individually for many reasons... one up front would be... Everyone has an opinion on the best recommended choice.. and I am not interested in competing to share what I hae either learned or experienced... if a patient or person asks me what I do for a living then I am fine with telling them. BEcause of my associations and jobs I feel that it might appear that I am trying to convince or act as an authority on a certain given subject. When I talk with someone I want it to be with the most true and accurate info that I have found... I also wont slam doctors or hospitals anywhere in the world... I was taught as a young girl that...

1. If you dont havesomething nice to say, say nothing....

2. If I slam someone else, it says more about me then the place I am slamming....

So, all these postings have been really interesting... It just seems to be a real hornets nest. I didnt come on here for at least the first 3-4 years that I have been working in this field because I didnt want folks to be confused who I am... Or be accused of what you are suggesting.

I now work very hard and when I have a few minues, I dont mind coming out and helping others.... Sorry if it comes across (to you and wassabubblebutt) that I am not saying who I am... but that isnt really true.... I want to come across as a bariatric success and share that... when and with whom I choose. I read posts quite often.... some just touch my heart to the point that I feel that I may be able to encourage or steer them into a better direction (not a better doctor)....

As always best wishes...

As I appreciate it seems you have the best intrest at heart, I think this is the reason why patient coordinators are not allowed to post on here .

Because TRUE intentions are so hard to know . Personally I think if someone is a patient and happens to work for a doctor yet comes on here and posts AS A PATIENT i dont have a problem with it. But i still feel you were trying to help , help as it maybe as part of your job, and i dont think this is the place for that .

That's just my opinion . Now maybe doing it off list and PMing people is ok ? I dunno. But again , i think coming on here and saying " I can help you PM me here is my WORK # and my WORK email , and not disclosing you work for a baratric surgeon is shady . I think you did it because you know its against the rules .

Just my input

Mindy

Sorry Mindy but you do have it wrong... I put my my number and my email on the postings because I want to be transparent, not shady... I dont have a job description nor an agenda.... I will be there to encourage and answer questions as I feel necessary... I have to let you know that because of all this craziness.... Folks are writing to me personally asking questions and thanking me for standing up and taking the time to explain who I am.... Its sad that you cant let this go.... I feel you know that I am here with the purest of intentions and you still continue to try and cause negative reactions... Tell ya' what.... call my business line and tell me that you have the band and you are having complications... and see how I handle your call... If you think I am out here soliciting.... Do the research before accusing... my number is 866-484-2263. By the way... I wish this lady that is on Medicaid could read what you have posted.... I have been helping her to get the band in Mississppi and telling her the next step ...each step of the way. I will never be quashed by the negative things you may post. I will continue to help all that I can. I feel because of my intentions, I am successful... Because if you dont get hung up on "making $$" and just share and help.... You will be blessed... I have been blessed with the folks that I have helped regardless of who did their surgery and if I assisted them in Mexico/States.

I have one request from you........

Everytime you feel the need to post something about me... answer at least 2 posts where someone needs help. That way not all is lost.

Sorry Mindy but you do have it wrong... I put my my number and my email on the postings because I want to be transparent, not shady... I dont have a job description nor an agenda.... I will be there to encourage and answer questions as I feel necessary... I have to let you know that because of all this craziness.... Folks are writing to me personally asking questions and thanking me for standing up and taking the time to explain who I am.... Its sad that you cant let this go.... I feel you know that I am here with the purest of intentions and you still continue to try and cause negative reactions... Tell ya' what.... call my business line and tell me that you have the band and you are having complications... and see how I handle your call... If you think I am out here soliciting.... Do the research before accusing... my number is 866-484-2263. By the way... I wish this lady that is on Medicaid could read what you have posted.... I have been helping her to get the band in Mississppi and telling her the next step ...each step of the way. I will never be quashed by the negative things you may post. I will continue to help all that I can. I feel because of my intentions, I am successful... Because if you dont get hung up on "making $$" and just share and help.... You will be blessed... I have been blessed with the folks that I have helped regardless of who did their surgery and if I assisted them in Mexico/States.

I have one request from you........

Everytime you feel the need to post something about me... answer at least 2 posts where someone needs help. That way not all is lost.

OH I ASSURE You I answer quite a bit more than 2 posts a day to help others. I like to repay what the boards have helped me out when i got banded. My only point is that I think you should have said who you worked for. I dont personally care if others think i cant let it go. That's not my intention. When I asked the question about if coordinators got paid or not I really was curious. Maybe i shoudl have PMed you personally . I think you may be trying to help others , but unfortatly the people who have come before you who were not make it look bad for others. ya know ? I think you can understand that. Do I KNOW for sure your here with the purest of intentions ? No , i am pretty sure. Am I causing problems on purpose no , Im trying to understand. I dont see what is wrong with that. You can see from my others posts Im not a trouble maker .

you can also see that I DO HELP People .

Mindy

lpbndinfo,

I'm sorry that you feel like you're having to defend yourself so much, however many people on this site know full well the horrible reputation of Betancourt. Therefore, when you come on here and try to recruit business for them, you're probably going to run into a problem.

If you indeed are recruiting patients for them, it is your responsibility to know the goods AND the bads. You say that every patient you have talked to had a good experience. I, personally have not been able to find any former patients that did not have complications or a bad experience per Andres.

If everyone would stick to their story, their personal experience and didnt gossip.... Because gossip is taking one persons story (hearsay) and spreading it like wild fire. Before posting things about doctors it may be wise to ask yourself.... IS it true? Is it accurate? Has the person posting these horrific situations been checked out to see if it is their experience. Are you sure that the person posting doesnt work for a doctor and wanting to stop business for another team?

My information about Betancourt is not gossip, it's first hand experience. It is true. It is accurate. I have the medical bills to prove it. And I can assure you that I do not work for another doctor.

So, here's some non-gossip facts:

1. I was lied to about the type of band that was used (not FDA approved)

2. The pics on the website did NOT match the facility where the surgery was performed. VERY dirty.

3. Got a life-threatening infection, that I am STILL dealing with... 2 years out.

4. Received no help from Betancourt with after care, and was even threatened to be sued.

5. Had a horrible time finding a dr to treat me in the US because Betancourt could not/would not provide any type of medical records. I believe the excuse was that there was a flood in the medical records dept (in Tijuana??)

5. Received several threatening and unprofessional voicemails post surgery from Andres, the owner (for sharing my experience).

6. I've had to spend weeks admitted in the hospital on IV antibiotics.

7. Don't even ask about my medical bills

8. Have had about 5 unsuccessful day surgeries to try to eliminate the infection

9. My port was upside down, had to be flipped.

10. Problem, upon problem, upon problem.....

But, if you're wanting more "gossip" I can refer you to several other former patients that have had life threatening complications. I met 3 other patients that had surgery at the same time/place I did, that i've been able to keep in touch with. 2 of them developed MRSA, one had to have her band completely removed, and I developed pseudomonas. So, Betancourt was 0-4 just in that one day.

I give my work phone number and my work email (and it's my personal as well) so that it IS understood that I am someone that works in this field.

But you really didn't present yourself as a person that makes money by sending people to docs that don't have the best of reputations. Quite the opposite, as a matter of fact. You claim you want to "help" people with insurance battles. Isn't it true that for a fee you will help them find a doctor from your list. I know your list and honestly, it's not great.

I don't know, call me silly but to me true help is helping people find the good stuff as well as the bad on doctors. It's not as difficult for a US citizen to find info on US doctors, it's our system, our culture for US people. But when someone is considering surgery outside the US they don't always know how to go about researching a doctor. It's their system and their culture. They do things differently.

Seriously, how much "help" are you really offering to a future patient when you flat out admit:

You won't tell the bad aspects of a doctor,

You imply that anything bad is rumor,

You can read for yourself personal horror experiences of YOUR doctors,

You don't fully disclose that your help is with a fee,

And your docs aren't those with better reputations.

Not only that, I feel that if I wanted to be shady I would do a better job at disguises... and use the username msfluffbunny or something non-related....

Ohhhh, we disagree on this point. When you come here offering to help by sending someone to a questionable doctor with a poor reputation, that's not shady behavior? For goodness sakes, YOU wanted to send ME to Betancourt! Who needs that kind of help?

Oh to address your first question.... I dont work for "a" doctor... I work with several docs in Mexico and the states.... What I do with absolutely no $$ in my pocket, is help people that are having problems...regardless of who did their surgery, help those who DONT have the $$ find a way (in the states and in Mexico), and if someone is just plain scared I dont mind talking with them and encouraging folks....

(emphasis my own)

So does most every single person posting on this forum! Only WE don't work "with" doctors. We also do not get paid for helping people with problems (read this forum much?), we don't care who did their surgery we just want to help if we can. We help people find ways to get surgery in an affordable manner but to suggest you don't charge for this, you already admitted this is your business. Care to pick a stance?

Not everyone that is here to help... has their hand out.

Um, 99% of us don't. You want to help for a fee yet you don't have your hand out? Can you explain that? Let me ask this, do you make money from sending people to doctors for surgery in the US and Mexico or not?

I have no problem with patient coordinators as long as they are honest about what they are doing and suggesting quality doctors that are safe and skilled surgeons with good reputations.

In another thread you claim that Betancourt was forced to work for shady doctors and dirty hospitals. I'm still waiting to hear how an unlicensed MD is forced to work with shady doctors and dirty hospitals. Did they handcuff him and drive him to work daily with a gun to his head when he recruited people and gave them infections in clinics with no running hot Water? How the heck was this man forced to work with some of the worst docs in Mexico?

I have come on here more in 2 days then I have in 2 years just defending myself with all of crazy paranoia that seems to be present.

Crazy paranoia?? OMG! I can't believe you actually wrote that. How can you say that when you refer people to bad doctors? Other patients that have gone to the very doctors you suggest and have infections, have had to have their ribs removed because of infection that went into the bone, people that have been battling infections for years, people that you appear to gloss right over. When confronted by the very people you claim are "rumor" you infer they should go back to the shady docs that gave them infections, and for what? So they can get a whole new infection? There are people that have lost their bands, some have very nearly lost their lives and some probably HAVE lost their lives and you call this crazy paranoia?

Look, there are many good surgeons in Mexico people can go to but if they don't have ALL the information (such as when you flat out explain you will not provide the negatives on doctors), how are they to make informed choices? Take your word for it? Are you serious? There are good surgeons and bad ones in EVERY country, no country is immune from the bad doctors. But to claim this is anything but what it is, is nothing short of sad.

I'm still absolutely floored that you call this crazy paranoia. And you then claim to call this help that you don't get paid for??

This boggles the mind.

I also wont slam doctors or hospitals anywhere in the world... I was taught as a young girl that...

1. If you dont havesomething nice to say, say nothing....

Did Momma know you were going to grow up and send people to surgeons with poor reputations? I'll bet she didn't....

Did Mom suggest anything about honesty when she was teaching you life issues as a young girl?

So glad you posted, you have done more of a service than you realize. See? You really have "helped" people today.

I have one request from you........

Everytime you feel the need to post something about me... answer at least 2 posts where someone needs help. That way not all is lost.

No need to request that ColtonWade do that, she already does and a whole heck of a lot more than you imply or request. We ALL do.

Just because some of us disagree with your motives, methods, or your list of docs does not mean our lives are wrapped around you. This is a message board and people are free to provide info, thoughts, links, etc.

How many posts does Coltenwade have? How many do you have? Who is *really* doing the help here?

Could not have said it better myself !!!!

Mindy

... I finally got to a helpful person who told me that - oops - you need a 6 month physician supervised diet program.

That's what I would say to this.

Before I accepted the fact that I was just notified about a 6 month delay I would talk to the supervisor and the supervisor's supervisor at my insurance company. I would even write a letter to the CEO of the medical insurance company (which actually is what I did) before I would accept this.

I work for a medical insurance company, and I do not believe that it is the policy of insurance carriers to try to get you to give up so they don't have to pay for something. They have policy and procedure and if they didn't want to cover WLS they would just exclude obesity treatment (unless coverage is mandated in the state where they are located). Any reputable insurance company does not play the kind of games people think they do. I'm sure there are some out there that are willing to play these kind of games... but really I'd guess most don't.

I'll get off my soapbox for now and just say that when you make a phone call to a medical insurance company they are probably somehow recording your call. Either with a tracking on their system, or an actual voice recording... and often times both. In speaking to the supervisor I would reference prior phone calls where you were never informed of the 6 month medically supervised diet and that you would be near the end of this now had you been informed in the beginning.

I would start the medically supervised diet, but would continue to fight this until it became clear I couldn't win (or you complete the 6 months)... and I would make them be REALLY clear about what they want you to provide as part of the pre-auth submission.

I consulted with a case manager while I was going through the pre-auth process and she told me that I needed to have a monthly office visit where I am weighed and it is discussed what I am eating, all tracked in chart notes by date. Mine also required a 5 year weight history showing that I was at least 100 lbs overweight that entire time, but that is something that my doctor did at all my regular office visits and physicals. They'll also require a psych evaluation, and if for some crazy reason the insurance company doesn't require this then the surgeon should.

Best of luck to you!

This is just my thought but I would think that the docs office would have a pretty good idea if this particular insurance company will cover the band or not ? They deal with it every day and they should be able to say " look we have seen these covered or not " so at least you know if there is a chance"

Again , its just me thinking LOL

Mindy

Hi. This is my first post, but I've been lurking around in here for a while. I finally got banded 1/9/08. I had to do two 6 month diets, because the ins co. did not like my doctors documentation on the first diet. They told me I needed to do another diet, and then they could approve me.

I went to another dr, my pcp, and redid a whole more 6 months. And guess what? Thery turned me down again. They didn't like my drs documentation. I went back to my pcp, crying. She wrote her notes over again and I resent it to the ins co. Then they said we need a weight from 2003. I had given them weights for 11/2002 and 1/2004, but not 2003. Well I finally found one and sent that. The moral of this rather long and rambling story is: THEY DON'T WANT TO APPROVE YOU. IT COSTS TOO MUCH MONEY. But don't give up. I finally got approved. Maybe they were just tired of me. Whatever--it worked

Good luck and if you have to do 6 mo diet--it goes by really quick!!