Hi Guys, I am new and Really need your Help...

Hi Guys,

My name is Tina and I am from the burbs of Chicago. I started the process with my insurance back in October of 2008 and I am still fighting them. I had to hire an attorney and go into a war with my HMO to get the approval, and still no success.

We also filed a complained from them to the Department of Insurance and now they are on their ass about it. The whole situation is that they will approve the surgery but dont want to approve it with the surgeon I want. My surgeon is affiliated with the medical IPA I belong too but he sees HMO patience only under a contract with the hospital. Basically, he is not on their payroll but they have signed a contract with him, allowing him to see HMO patience because they want to keep him in the hospital. That gives the Medical Group an opportunity to hide him, and send patience to cheaper doctors. Its really ****** up.

So, I am going mad here.I feel like I have hit some hard core depression. All I do is cry. I need some incouragement and kind words from fellow souls. Tell me your stories, make me feel a little better.

Thank you

Hi Tina -

Sorry you are going thru such a hard time.  Why not change insurance companies or surgeons?  If you are at your lowest, I would be finding another doctor who was in network.  I love my surgeon, Dr. Jeffrey Rosen with LifeWeigh Bariatrics out of Downers Grove.  Dr. Rosen and his team are absolutely fabulous.  They are their to help you thru all stages and it does not stop shortly after surgery.  They are there for life, when you fall, they pick you back up.  It's an amazing group of people.

I was blessed with having gastric bypass on 8/30/06.  Day of surgery, I weighed 404.  Today I weigh 240.  I did have a 12lb regain but I'm not sweating it.  I'm back on track and will get to where I want to be.  I do have to admit, for me, it has gotten more difficult the further I get out from surgery.  I have to really discipline myself.  Portion control and exercise are very important.

Good Luck on your journey.
Christina

Dear Tina:

I am sorry to hear that you are having such a rough time.

I agree with Christina.  If you are approved for surgery, go with a surgeon that is in network. 

You can check as to WHO is approved by your insurance company, then come here to research those surgeons and chose one. 

I too fought insurance for almost 2 years before approval and sometimes, you just have to bend to them.

I hope things look up for you soon!

I had a very similar situation where even though my surgeon did not want to operate on me there was no other optin within my HMO.  I feel my surgeon is as good as those I would have prefered but I did have to go further than I would have liked for surgery, to UIC, when there is a center of excellence right across 53 from us.