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  • Name: Kristen B.
  • Username: pandasan
  • Location: Owings Mills, MD, USA
  • Member Since: 4/3/2008
  • BMI: 40.2
  • Hoping to have surgery
  • Surgeon: Michael Schweitzer
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Get insurance approval

33 People
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complete my paperwork and all test required for insurance approval

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pandasan's Blog
pandasan's Blog

Hmm.. Decisions...
posted on 4/21/08 11:52 am
So, I had my consultation this morning. I met Dr Schweitzer, he seems very smart and to the point. Prior to meeting with Dr S, I met with another Dr (on his team? I missed what he said...) who was very nice and went over my medical history with me. He really seemed to want to push me away from DS and to RNY, but I think I'm pretty determined to go with the DS at this point. Before I left, I met with a lady named Teresa who called my insurance company to try to get some straight answers out of them. They essentially said what they've been saying all along - that it is excluded from my benefits. I know there is a clause in my benefits that states that all things listed were not all-inclusive and whether something was listed as excluded or not, the final determination is made at the time I file a claim. So pretty much, they won't tell me what I need to try to get approved. This leaves me with 2 options.

Option #1 
Begin a 6month doctor monitored weight loss plan and after completing my psych and nutricianist consults, file for approval and hope they approve me. This option would mean I probably wouldn't be able to have surgery until January 2009, and even then, Dr S is not in network, so his fees will only be 70% of 'reasonable and customary' covered - rest on me.  It would take me longer, but it would be much cheaper.

Option #2
Get a loan and pay for everything myself. If I take this option, it will be expensive. They estimated I would have to pay ~ ,000 for the surgery (including surgeon's fees, anesthesia, hospital fees and some follow up- 9 wks maybe? I don't remember at the moment..) I would also have to pay for any follow up visits (0-0) and possibly lab work (the lab work could be covered if they code it as being malnutriction related and not obesity related)

So what to do... I know my mom will not like option #2 (I don't think she'll like option #1 either though!!) I keep trying to tell myself 'it's only 6 months' and 'it's not like I'm gonna die tomorrow from my obesity!' but at the same time I am very anxious to have it done.

As much as I hate to delay surgery, I'm thinking I might just have to go to option #1 and work hard to get approved by my insurance. I'm not made of money, and even if I work so hard and still get denied, that's 6months I can be saving up to pay for the surgery myself. (Well, maybe more like 4 or 5 months... my current savings money is going towards my new apartment at end of june...)

Anyway.. I have to make some decisions and talk it over with my boyfriend... and maybe mom. I dunno though.. I don't think I'm gonna say anything to her just yet >.<;

To do list:
Schedule psych appt
Schedule nut appt
Look into 6mo WL plan options w/ my PCP or John Hopkins


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