I posted the other day......

I posted the other day... 2 weeks ago, i thought i was on my way to getting approved. but the paperwork wasnt submitted because my insurance company kept telling the surgeon's office that they needed more and more papers from my doctor. I also was in touch with my insurance company and they were working with me to get the necessary papers in line. Then the one insurance woman told that it would be so much easier if i would go with an in-network surgeon. well, dummy me ..who knows nothing about insurance issues. Let her tell me of a great surgeon that is in-network. So i am trying to get an appt with the new surgeon and they send me a letter stating that i am not covered. So i get on the phone to my insurance company ready to blast them for getting my hopes up,. telling me time after time that i am covered. they tell me that they dont cover weight loss products and things of that nature but wls is approved on an individual basis providing you meet their criteria and I do. (over 100 lbs overwieght and co morbs and must be a medical necessity, and i have the doctor's papers stating that and everything). the surgeons office is saying that is not what they told them and i am still waiting for them to hash this out. why would they tell one surgeon is covered and another that it isnt.???? i have been told to go to my husbands HR person at work. And he says its covered and has been covered before. Do i have a chance of getting this surgery? a few weeks ago, i was told by my insurance company i was ...now i am soooo sad... please someone cheer me up...olr how about giving me some other surgeon's names to try. Anyone get an appointment right away? i have been to so many seminars i feel like i could teach one. I would rather skip another one... most make you wait months and months for a seminar anyway.. i have been patient. i need someone to make me smile...help... take care kim

Kim Good morning!! First of all...take a deep a breath...everything happens for a reason!!! Having a *in network* doctor does make a difference as far as the insurance goes. The insurance pays better benefits for an in-network provider. Who is your insurance through?? I have humana and I'm seeing Dr. Shina in Louisville. I see that you live in south central Ky, so do I!!! I live in Hart county. You can e-mail me at [email protected]. it is a long road it seems once you have decided you are ready for the surgery BUT everything happens for a reason. Believe and have faith that everything will be fine. I will be gone most of the day today but will check my messages late tonight or in the morning!! Blessings Tonya

Hello Kim. Don't give up. If your insurance has an network then they should have a directory of doctors who are in-network. I called my insurance company (Private Healthcare Systems) and requested the directory for my state then went on the internet and started matching names of baratric surgeons to the surgeons in the directory. I found Dr. Shina who is really great. I also called and confirmed that he was still within my insurances network. My paperwork was submitted within two weeks after I went to Dr. Shina's seminar and I got approved in writing by my insurance within a month and as an added benefit they will pay 90% instead of 80% because he is in the network. Good Luck and God Bless, Karen

Hey Well I am glad to see You are finally getting somewhere. I have thought about You, Wondering how things were going haven't seen Your face for awhile. St. Josephs East Dr. Nighbert, Dr. Steiner, & Dr. Green Lee are in Lexington they are great From the time I called to schedule an appointment for the seminar to the time I had my surgery was a total of ( O.K. are You sitting) 39 days. Of course I didn't have to get pre approval but they move fast and are really good at what they do. Plus they will get to the bottom of things for You. There was only 250$ I had to pay in two payments first visit and last visit (after approval for those who need it) before surgery. I would check them out. They are called The Center For Weight Loss Surgery there number is 859-967-5520 I Wish You The Best keep us updated. 287/226/150 Shell