Stricture saga continues.....& I hate HMO's

So after the 5th stretching......It still didn't work.  I saw my GI doc yesterday and he said at this point he is referring me to a specialist out of UCI  Dr. Lee to have a stent put in.  However, he also told me that he knows my insurance (my IPA) will deny it and it will take time to fight it. blah blah blah...then he dropped another bombshell.  He told me that his contract with my IPA is ending and he will no longer be accepting my insurance through my IPA.  so I either have to switch my IPA which I don't want to do because I will lose my other Doctors....especially my PCP, but I don't want to have to start all over again with the GI thing.  He said it could take up to 6 weeks to even get the official denial from the insurance.  What a mess.  So it looks like I am stuck with both the stricture and ulcer for a while. 

Thank you all for the support you have given to me.  I appreciate all of you

Linda

Wow sweetie..  when it rains it pours huh..

I was so hoping this last stretching would be it for you. I am so sorry to hear that you are still having problems with it, and now you are having problems with your Doc's insurance decision.

Do some research, get all your medical records from your GI Doc now, keep that chin up and it will eventually all work out. I know that it is frustrating to start over again with a new Doc, but maybe it will be a blessing in disguise.

I pray maybe he is wrong in thinking that it will automatically deny it, and that they may be able to get you in before his IPA insurance ends. Don't loose hope..

I sure pray that this all gets worked out for you. I am always here if you need to vent..

Hugs to you hun, and try to enjoy the rest of your TGIF, and weekend..

Jenn

Thanks Jenn,

I appreciate it.  Your right.

The reason he is pretty sure it will be denied is because UCI isn't a contracted hospital.  He is totally outside of the network.  But I am hoping once he tells them that this Dr is the only one the area that performs this much needed procedure, it will speed things up. 

Linda

Wow, all of that truly sux!  I don't know if this will hel*****t but I will put it out there.  As for the insurance taking so long and you having to change it, etc., this sort of happened to my ex a few years ago.  He needed an angioplasty after having a angiogram.  Well, the insurance we had at the time (anyone remember Lifeguard?) was going belly up in the next few days and then we would be caught in the hell of transitioning to a new insurance, etc, just like you. 

The doctor then did a wonderful thing for us.  He performed the angioplasty as an urgent procedure.  Because he told the insurance Mike HAD to have it now because it could become life threatening, Lifeguard authorized it immediately.  Maybe your doc can do the same type of thing?  Just a thought.  Maybe you can let the doctor know how terrible the pain is and you just don't know how you can cope the next few weeks, he could use this as a basis for an urgent procedure??? 

Good luck Linda.  Thinking of you.

I'm new to this site cause I have just set my surgical date. But I noticed you are from Templeton,CA....  I lived in SLO county for 30 yrs.  Moved up to Beaverton,OR for a couple years and now back down to Folsom,CA  to have my 2ND husband's retirement with the State of CA.

I used to work at a Surgery Center in Templeton billing surgical procedures including Lifeguard.  I also had Lifeguard when I was still married to my 1st husband of 25 yrs.  They were the best HMO to deal with.  I got caught when I was separated not being able to have a bunionectomy done at Sierra Vista cause the Sate of CA drove them out of business by dropping them on their list of Insurance Companies.  They went bankrupt after that.

But they were good to work with at least form a facilities point of view.  I only coded for facilities and not for PCP offices. I had heard it was tougher for them but I never had trouble when 
Dr. Lemm would refer me where ever.

My name is Kiki.  User name is Kiki_1.  It was good to find someone from Templeon, CA on this web page.  I lived in Templeton for 10yrs.

Take care jilliecats

What a small, small world!  Gordon Lemm is my boss' best friend.  Well, I should say my ex-boss' best friend since I don't work anymore.  I live off of Horstman in Templeton, by Las Tablas Road.  I was born and raised in Paso and moved to Templeton in 1996 for the schools for my boys.

I really did like Lifeguard.  They were always very very easy to deal with.  Before Lifeguard, we had Health Net, which was good as long as you had doctors thru SLO Medical Clinic.  Most of those docs were quacks and the good ones wouldn't take new patients so it was wonderful when we got Lifeguard.  I did not know why they went under, but was very sad they did.

Are you getting nervous about your WLS?  If you don't mind me asking, how old are you?  The huge regret I have about WLS is the fact that I waited so long to do it.  My kids were pre-teens by the time I decided to do it.  I wish I had done it back when they were babes.  Oh well, can't do anything about it.  Timing is all for a reason.

I, too was married for 25 years by the time the divorce was final.  I am single now, don't think marriage is in the cards for me.  Did it once and didn't do it right so probably won't try again   It became final just last month.  Yippee!!

Oregon is a beautiful place to live.  Keep in touch!!!

Hugs to you!!

Dear Kiki,

I hope you don't mind my responding to this post.  You are not too late.  I did this when I was 55, I am 5' 1/2" short and was over 100 lbs overweight.  I have lost over 100 lbs, and at age 57 have never felt better. 

I wish you all the success with this. 

~Naomi

Linda,

That just sucks.  Is there anyway you can call your insurance and talk to them and tell them what has been happening and maybe someone will have some mercy for you?  I can't even imagine how frustrating this all has been for you.  I will continue to pray for healing for you.  Take care my freind.

Rhonda

Oh Linda...I can't imagine how you feel.  Cause this HAS to be the most emotionally draining time of your life, but I have faith that it will pass and although it's been almost a year it will just be a small blip on the radar sooner then later.  You remain in my prayers.

Ms Shell