Confussed about process

[Biker Deb 0]

I did what I thought I was supposed to do and started by going to a seminar. From there I called my insurance company, Presbyterian, and started working with a nurse care coordinator. Luckily the woman I am working with has been great; unfortunately my insurance won’t approve the doctor I want. I’m still looking for a doctor I would feel comfortable with and not having much luck. There are none in New Mexico, except for the one my insurance won’t allow, so finding someone I’m comfortable with is not so easy.

My confusion comes because most of the posts I’ve read say that everything starts with the surgeon. They require the visits to the other specialists and after everything is done they submit the paperwork to the insurance company. My nurse care coordinator has not said anything to me about not having a surgeon yet, but I’m still a little worried about it. Has anyone else started with the insurance company and then found a surgeon after they were approved?

[Bamablondie1 0]

Welllllllll........ for me, my surgeon's office was the one that submitted the request for approval. All the other dr's I had to see gave 'clearance' to the surgeon's office and then the surgeon submitted my 'history' along with testing results, additional diagnoses, clearance and other items from the group of doctor's to get the approval from insurance. The surgeon was the one who decided that I needed to do the sleep study but not the psych eval... needed to do this ... but not that... etc. So the initial consult that I had with him after the seminar kinda directs me to his requirements while they keep in mind the insurance requirements as well.

Have you asked the nurse care coordinator what bariatric dr's your ins might cover? Do you know of anyone you work with that has had a weight loss surgery that was covered by the same policy? Is there an option to swap insurance policies at some point?

[ParrotheadCathy 0]

I agree with Bama Blondie. Call your insurance company back and ask for a list of bariatric surgeons who do lap band surgery in your area. that way, you're only researach docs who are approved by your insurance. Pick one and make an appointment for a consultation (you've already done a seminar and can probably not have to go to another one). The doc's office will order whatever pre-op testing they require and submit everything to your insurance company for approval.

[Biker Deb 0]

Thanks! I'll call the coordinator today. I just don't want to do something wrong that will put this off. I will definitely have to travel to have it done, it's just decided which direction! At least having a list of approved surgeons will help.

[dyingtobethin 0]

Well for me I called my local hospital and they have a program that offers a free weight loss seminar and they already have a group of bariatric doctors who come there and do the surgerys and we just choose from the surgeons that perform the surgery there. contact your local hospital and see if they have surgeons that perform these services there. Hope this is some help to you.

[Melinco 1]

Deb, is it possible your insurance would reimburse you if you went to an out of network doctor? I know that Dr. Kirshbaum in Denver is quite popular, and his cash price is around $9500. Not sure what you would do for fills though.

Dr. Smith in Pueblo would be closer, but his cash price is about $14,500.

What part of NM are you in?

[Biker Deb 0]

I'm in the Rio Rancho/Albuquerque are. There is one doctor that is coming in from Texas and starting a program at the local Lovelace hospital but my insurance said they would absolutely not cover that. They are pushing me to go to El Paso but I went to the seminar and really didn't care for the surgeon. If that is my only option I will go, but I'd rather like the person cuting into me.

[shadst8 8]

I did what I thought I was supposed to do and started by going to a seminar. From there I called my insurance company, Presbyterian, and started working with a nurse care coordinator. Luckily the woman I am working with has been great; unfortunately my insurance won’t approve the doctor I want. I’m still looking for a doctor I would feel comfortable with and not having much luck. There are none in New Mexico, except for the one my insurance won’t allow, so finding someone I’m comfortable with is not so easy.

My confusion comes because most of the posts I’ve read say that everything starts with the surgeon. They require the visits to the other specialists and after everything is done they submit the paperwork to the insurance company. My nurse care coordinator has not said anything to me about not having a surgeon yet, but I’m still a little worried about it. Has anyone else started with the insurance company and then found a surgeon after they were approved?

I was referred by regular doctor to the surgeon's seminar--at the end of the seminar, you filled out a form to have them contact insurance to see if they covered the surgery--I then filled out a weight history to see if I was a candidate--then I was accepted as a lap-band patient. After my first appointment I was assigned a patient rep who basically contacts your insurance to make sure everything gets approved and paid for--I met with her on the first visit. My surgeon set up my other appointments (sleep apnea, psych eval). After my last appointment, I was approved a week later!