Talia
Hi EVERYONE, a 32 year old wife and mother of three Christian, Kennedy, and Jay. In the past I said, I gained my weight through my pregnancies but after some thought I realized the weight started my senior year of high school. I believe I was 20lbs overweight but body image was not a concern for me for some reason. I guess I never thought I would get up to 270lbs. Well, I have been looking at WLS for 3 years now. My husband's insurance did not cover the procedure...it was a horrible policy. Anyway, going forward into the present, I am returning to work after staying at home for over 5 years...yeah! I would be pursing some educational goals but since Katrina, the cost of housing, utilities, and other life needs has soared to astronomical prices. It has gotten so bad I am considering moving to Virginia or North Carolina; at least the premium cost would be worth it. The city does not offer anything to young couples with children…it would be ok if I was looking to retire but then there are no conveniences to make me want to stay at any age.
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September 28, 2006
- After extensive research, I filled out the online registration with Dr. Drake Bellanger to start the process. I also called my PCP and OB/GYN to arrange a medical visit since I have not seen a doctor for a couple of years. Not that I did not want to but I did not have enough insurance...I am nervous about what my pre-op test may reveal-I think I have type 2 diabetes but I am not sure.
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October 2, 2006
- I called the Doctor's office to verify they have my registration and to make an appointment this week with no prevail, I wait. The woman on the phone said they had my registration but the woman who processes the paperwork is back logged and will be contacting me when she verifies my insurance. Of Course, I did that already. The only concern with that is, I do not know what all I have to do to qualify with the insurance. The BCBS rep said, “if your doctor deems it medical necessary, I hope it is that simple.
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October 6, 2006-
----Today, I decided to give Dr. Drake Bellanger office a call. Well, I am glad I did because, Kim, the screening personnel, told me my insurance has an exclusion and she sent me an email regarding other options of payment. I check my mail everyday and I did not receive an email from this woman. I am sure DR. Bellanger office is overwhelmed with patients seeking information and those that are ready to began process, but I followed the steps to let them know I was indeed serious. Recently, Dr. Bellanger office has received recognition for being a “Center of Excellence” and as far as I know, his Surgical Center is the only one that carries that status in Baton Rouge.
Anyway, I am told these insurance companies tell patients they are covered butin the end fails the certification process. Apparently, there is a difference in certification and authorization. Ok, if your insurance have guidelines like unsuccessful weight loss in the last two years for 6 months, and a 5 year documentation of weight loss and height, PCP approval letter etc… this will allow you to get authorization approval, now, you must be certified through the medical broad to get certified to actual get them to pay. What a bunch crap????
This process is an attempt to discourage the procedure…”FOR WHAT”, I ask? To protect the bottom-line! Statistics shows the cost to cover obesity far out weighs having the medical surgery.
I spoke with Teresa, BCBS customer benefits, and she was so nice and was very frank. She told me what all I needed to do and is sending it in writing…..Teresa stated, there is a strict guideline that must be followed and when these steps are accomplished, it is submitted for approval. She also gave me her contact information if I have any more questions about my coverage and she will assist me with the process.
Armed with this new information, I called the office, the screening personnel, basically says from her experience, they deny patients even if they do all the steps. I'm thinking, she does not want to put the effort because my case is not a slam dunk and she might have to do some additional paperwork. Well, I was waiting for her to say one more negative statement before I told her that she should take every case with a different approach, whether approved or not each is worth the effort to the person seeking the services.
After I told her, “the Center’s website does not show any contact with BCBS of Illinois”, she quickly changed her position. I called BlueCross and they did not have a record of her every calling to confirm anything about the procedure but they do have my calls requesting coverage information---a policy of theirs to record all calls…hhhmmm.
Now, the office wants my policy information again and the phone number so she can ask the right questions…to bad I want find out until Monday. You guys are probably thinking.” change doctors” but I am sure the Doctors do not know when or if they lose a potential patient due to poor customer service. Like I said before, this Center has two doctors and they are highly recommended for what they do. This is a major surgery and I want the best!
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October 13, 2006
Some things have changed since my last email. I decided to look for another doctor. I am scheduled to attend a seminar on Thursday to review my options again. This doctor is within the network and he is the second doctor in Louisiana with the Center of Excellence. I am gathering my questions to see if he is the right one for me.As far as insurance, I need 6 months supervised diet with my PCP. I am hoping I can have the surgery in April. This week I have a round of doctor appointments and I will speak to my PCP about supporting my decision. I hope he is on broad...he did support my breast reduction so I am assuming he will with this.
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October 17. 2006
PCP appointment, not much happen with weight loss management today. Dr. was too concern about my blood pressure climbing the ceiling. I have to go back in 2 weeks so I hope I am healthy enough to have the surgery. Will post when things change.....
November 1, 2006
I have started my new job....I think I can do this but my supervisor is another story. Of course I have doctor's appointments and she is wondering why I have so many appointments that I can not manage around my work schedule. Well, I am not a manager so I can not leave the job and take care of personal things so I have to have a flexable schedule. (me saying this in my head)
I went to the seminar and it was informative ...I do have a book that I must read before I can schedule an appointment plus I need to have my weight history. I will be working on that tomorrow. If anyone can give me advice about what I can do to get my supervisor out of my business. (this is a state job).
Also, I will attend my first wellness Center appt. and I'm little worried but excited to get this process moving. My doctor is pregnant but will be available by the time I am ready to have the surgery. I am looking a January for my first appointment with the WLS surgeon.
