Dr. Keshishian? Dr. Rabkin? Revision Help!

Hello all. After much deliberation, I have decided to try to get a revision from LAGB to DS. I learned off this board that, in CA, Dr. Keshishian and Dr. Rabkin are the best surgeons for the DS. I've had a terrible time this morning with the receptionist at Dr. K's office and it's leaving a bad taste in my mouth. We actually got into an argument about whether bariatric surgery is covered under my policy or not. Bariatric surgery is specifically excluded under my policy EXCEPT when medically necessary. Many people stop reading at the first line. I have obstructive sleep apnea, high blood pressure, severe knee and back pain, incontinence... etc... my quality of life is definitely affected by my weight (260, BMI 47). It's medically necessary! This chickadee on the phone just really didn't feel like listening to me today. I had to call her three times to try to get through to her. I've been around this block before! Anyway, anyone have similar experiences with the gatekeepers at Dr. Keshishian's office? And does that reflect on how I'll be treated if I do get an appointment? Dr. Rabkin's phone screener was MUCH nicer and was much more accommodating! Any suggestions?

When I was exploring revision last year I spoke with both offices at length along with Dr. Stewart's office. The folk's I talked with at both Dr. Rabkin and Dr. K's office were very helpful and accommodating. Generally you speak with Lupe at Dr. K's office and she was nothing short of patient and helpful with all the last minute stuff and panic before surgery. I'm sorry you had a negative experience.

In reality, your insurance company will often determine medical necessity. I had strong medical indications for a revision including worsening comorbidities and structural problems related to my RNY and it was still denied. But, you never know until your try.

Hi there. Thanks for responding! I was hoping I could ask you a few specific questions if they are not too personal. Did you finally get insurance approval? If so, what did you do? What were the costs with the insurance? I understand the program fee is $4000. Is there anything else? I can't self- pay so I won't bug you about that. If you are able to answer, I'd appreciate it. I'm dying to know and I didn't have a positive first few contacts with the office...

Thanks!
Lori 

Lori,
I ended up being self pay.

Dr. Keshishian and Dr. Rabkin are both excellent surgeons. My surgery was with PacLap and I have no complaints about them. I accompanied a friend to a consult with Dr. K and this was also a good experience, and she was treated very well.
     Regarding your policy, I understand the frustration, but would suggest that you look further for language specifically regarding revisions. Even though you clearly meet the NIH criteria for wls, your policy may not pay for a second surgery. This applies even if they didn't pay for the first surgery...so all I'm saying here is to read the entire section on bariatric surgery very carefully, and I hope that your interpretation was right.
     I also hope one bad experience with one individual who has to deal with many different insurance policies won't sour you on one of your best resources for your DS.

Larra

Further to what Larra said, please obtain a WRITTEN copy of your bariatric surgery policy and post it here - and include language relating to exclusions as well, if any.  We can see if there is something that might have been misunderstood.

Thank you everyone! Here is what my policy states:

"EXCLUSIONS AND LIMITATIONS:

11. Medical and surgical services intended primarily for the treatment or control obesity. HOWEVER (emphasis mine), treatment of clinically severe obesity, as defined by the body mass index (BMI) classifications of the National Heart, Lung, and Blood Institute (NHLBI) guideline IS COVERED ( emphasis mine) at approved centers if the services are demonstrated through existing peer reviews, evidence- based scientific literature and scientifically- based guidelines, to be safe and effective treatment for the condition. Clinically severe obesity is defined by the NHLBI as a BMI of 40 or greater without comorbidities, or 35-39 with comorbidities. The following are specifically excluded:
** Medical and surgical services to alter the appearances or physical changes that are the result of any surgery performed for the managmeemnt of obesity or clinically severe (morbid) obesity, unless Medically Necessary or as specified in the "reconstructive surgery, and
** Weight loss programs or treatments, whether prescribed or recommended by a physician or under medical supervision. "

That's it!

OK, so here is the bottom line:

If this is the extent of the exclusions on bariatric surgery (and by the way, that exclusion on reconstructive surgery is against California law, but don't worry about that just yet), including no limitations on revisions, you should be covered.  (Which insurance company is it, by the way?)

Now, here's the thing: a bunch of people have told you that Keshishian's office is not known for being assholic.  We don't know who you talked to - maybe it's a new person?  Or if there was some other misunderstanding?  So why don't you put what you wrote there into an EMAIL and send it to the office with a nice subject line and preface saying that you just want to reassure them that YOUR policy covers bariatric surgery, and that you hope this clears up any possible misunderstanding.  If that doesn't work, a few of us have Dr. K's email address - but first, you should go through channels.  (We don't abuse giving out his email address for minor issues that can be worked out without getting him involved, and that way, we aren't cut off from access!)

Trust me, there are MANY surgeons' offices that are far far worse.  Dr. K gets the benefit of the doubt, at least for one round.

Hi Diana- Thanks for everything. The person I was dealing with is not new- her name is mentioned in many Dr. K posts- all positive. Maybe I just rubbed her the wrong way! After I posted this, I was told by the same gal I needed a referral, so I'm going to get one from my PCP Monday. I don't want to bug the doc yet- this was just my first few contacts with the office. Everything on the boards about Dr. K's office is pretty good so I must just be a blip. 

Regarding my insurance, I have Cigna HMO, but I found out today that Dr. K is in my network! Not sure why I need a referral then, but I'll do it!

Good idea about the email- I'll send one in and see what happens!

Thanks for all your hard work on these boards!~ 

Thank you for the email idea. It worked and Dr. K responded to me personally!