Anticipation...

Jan 11, 2012

Because this is my first post I have to give you all so background information. I just started taking B-12 shots with my PCP again and well GOOD NEWS!!! I'm down 8 pounds from my last appointment, which was exactly two weeks ago. So I'm extremely happy about that; I went from 311 lbs down to 303 lbs. And that is not the only good news...Today I was able to FINALLY find a surgeon who accepts my insurance AND schedule my initial appointment!!!! 

In order for you all to understand why this is such a milestone for me you have to first understand what I have been through, with regards to trying to have RNY Gastric Bypass surgery. I first tried to get the surgery back in 2005. I went to Dr. Lin at GW Hospital in Washington, DC. He was great! Well, at least he was at my initial consultation, I never made it any further than that. I gave up because there was a long laundry list full of things I had to get in order to have the surgery done AND before scheduling my next appointment with his office. Basically I felt like it was all on me. I had to track down previous doctors and get my medical records proving that I had been on a physician monitored diet for a year, get a Psych eval, and so on. The PCP that I had at the time had literally gone MIA. She was know where to be found. She was my family's doctor and none of us, or her other patients, could get in contact with her. So, do to my PCP going MIA I had absolutely NO medical records to submit to the insurance company which meant that I would have to start all over. So, being immature at the time, I simply gave up. Now, 6 years later I find myself once again needing and wanting the surgery. I have wanted it for a while but figured that it was simply out of my reach. See, I was laid off October 1, 2010 and now I'm receiving unemployment and have Medicaid, specifically Chartered Health Plan. After being laid off I took for granted that Medicaid would not pay for the surgery. Then through family I found out that some Medicaid plans do cover the surgery. So right after the first I went on-line to Chartered Health Plan's provider directory and searched for Dr. Lin. Once I saw that he was on their provider list I then called Dr. Lin's office at GW and asked if he accepted Chartered Health Plan. I was told by his staff (in a very rude manner) that Chartered Health Plan stopped covering the surgery back in 2009. So then I called Chartered Health Plan and asked them if they still cover the surgery. I was told by their member services representative "No." At this point I had a choice, I could give up or I could see if Medicaid offered me any other insurance plan options. I chose to press on. I called the Washington, DC IMA Change Center and was on hold for literally 37 minutes before speaking to someone. I told her my situation and asked whether I had any other insurance plan options. She informed me that I had 1 other option, United Health Care's Unison plan. I then asked her for their number and also for the number to request my insurance plan to be switched. I then called United Health Care's Unison and asked whether or not they cover the surgery. To my surprise the member services representative that I was speaking to had the surgery. She was extremely helpful. She told me that they do cover it if it is medically necessary. Then I asked her if my PCP Dr. Mamodesene was on their provider list. Once she told me he was I knew I HAD to change my insurance to Unison. So I called DC Healthy Families and requested to change my insurance plan. I was then told that I had to write a letter detailing why I wanted to change insurances, which would have to be approved. Then, to my surprise, the lady took down my statement and wrote the letter for me. She then told me she had to submit it to her supervisor for approval and that it would be a few days before they will call me back with their decision. So I waited. Monday I received a call from the same friendly voice at DC Healthy Families and I was told that my insurance change was APPROVED and that it will be effective February 1, 2012. This was my first milestone and I was so excited! I did not know yet that finding a surgeon who takes Unison was going to so hard. I immediately called Dr. Lin's office and asked whether he accepted Unison and I was told "No." I thought "No worries. I can find someone else on-line." I then found the Center for Obesity Surgery. I called them and once again heard "No." So then I called Washington Hospital Center's Bariatric Center and heard "No" again. After that I had the bright idea to call Unison and have them refer me to surgeons who accept their insurance. Unfortunately, the member services representative did not know what to search for so she ended up giving me numbers and names for the wrong type of doctor. At this point I felt stuck. I called Providence Hospital's Weight Loss Center and asked them if they accepted Unison. I was told that they would have someone call me back to let me know and I never received a call back. Then I found obesityhelp.com. I used this website to search for a surgeon and found many in my area. Then I looked up Unison's on-line provider list. I then went one by one and searched to see whether the surgeon was on the provider list or not. To my surprise Dr. Lin (and every other surgeon at GW's Bariatric Clinic) were on the list. Remember that I already found out that they DON'T except Unison. So this told me that the list needs to be updated and just because someone is on the list does not guarantee that they STILL except Unison. Despite this I kept searching. Then I came across Dr. Fullum and Dr. Tran from Howard University Hospital's Bariatric Center. BOTH of their names were on Unison's provider list. So immediately I called and after hearing an automated service which said "Dial 1 to schedule an appointment, dial 2 for general information such as our address, office hours and directions, dial 3 for insurance related questions and dial 4 for all other questions." I dialed 3 since my question was about whether they accepted my insurance or not. Well dialing 3 had me transferred to someones voice-mail. So I left a message with my information and my question. Two business days went by with no response. So TODAY I decided to call again. I once again dialed 3 and left another message. Then I decided to call back and dial 4. Dialing 4 only transferred me to a different person's voice-mail. So then I said "Ok, I more try!" I called once again, this time dialing 1. To my surprise the receptionist answered the phone. I then asked her whether Dr. Fullum and Dr. Tran except Unison. She said "YES!!!! They both do." I then told her that my insurance will be effective the first of February and she scheduled me in for Feb. 1st with Dr. Fullum. I've also scheduled to attend Howard University's weight loss surgery informational session next Thursday. I finally feel like I'm on my way to getting the surgery. I can't wait until my appointment on the first. I'm one step closer to my goal...

Also, I have a job interview in two weeks and if all goes well I might have to change insurances again lol. But the interview is for a federal government job so I know that their insurance is good. So if hired I should still be able to get the surgery through their employee insurance plan. Until next time...

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