I am soooo upset!

I am not sure, how long it took Kim. But for me from beginning (referral) to end (surgery) it was about a year..  And pre-op, I only visited Maine Bariatric 3 or 4 times.  They can schedule your visits on in one appointment most likely. (meeting with surgeon, Nutritionist & Therapist)  You can have your gall bladder ultrasound done for sure up in Lewiston.  And if you have to go to emotional therapy (I am an emotional eater, so at my psych consult with ME Bariatric, I was required to see a therapist on my own weekly for 3 months. And for that they have a list and you can do that in Lewiston.  I was disappointed at first when she told me that and it would be at least another 3 months before my surgery, but it really made a difference in my life and I learned a lot of things about myself.  And it gave me the time to really realize how ready I was for this surgery and that maybe I wasn't quite ready before I had the therapy. 

You certainly have a right to be upset, but use that energy to your advantage.  Be pro-active and find out exactly what paperwork was submitted & when, who denied it, etc.  Knowledge is power.  You need to keep track of all the facts.  Definitely appeal this decision.  In most cases, you can appeal more than once if you need to.   In the meantime....it doesn't hurt to check out your options with a different facility.  Is Augusta any closer to you?  MGMC also has a Bariatric Program with Dr. Trieu.  I can vouch that he's a great doctor as well.   No one makes the decision to have wls lightly, so you obviously have already determined that this is the direction you want to go.  Nothing has changed.  It's still just as important.  Keep the faith.  There is a way! Blessings, Yvonne

Thanks for the encouragement.  Dr. Loggins office called today and wanted to know who the medical director was that denied it, what happened (what they said about competition), etc.  They said they spoke with Dr. Loggins and he was going to personally try to do something.  So that is great that they will look into it for me.  I also called hr and found out that to appeal I just need to write a letter explaining the cir****tances of why I want him etc. I also (see being proactive like you all suggested) called Dr. Trieu's office and asked about the wait time.  She said it would likely be a few weeks to get into his office for the first visit (after I went to an information class or something), then it is about 9 months to do all the other stuff etc before the surgery.  She said even though I just had all my bloodwork done, ekg etc that I would have to start over and do it again. How long did it take you start to surgery??  I am going to wait and see what happens with the appeal/ or dr. loggins talking to them then will go from there.

My wls process took almost exactly one year, but Dr. Trieu had just joined MGMC at that time and was waiting for his credentials to be approved by insurance companies, plus later I was denied twice by my first insurance company so there was the appeal process time and then a few months after that before we signed on with a new insurance company that granted me an approval.   Most of the patients that I know of from the Augusta Center have gone through the process in about 6 months.  I know that they are short-handed one Dr. right now, so maybe that's why they are saying it might take 9 months.  It's a shame that all your testing would have to be done over.   But I think the reasoning is because the Augusta process is backwards from most of the other centers.  You see the Dr. first, then start your evaluation process, usually with the Psych eval, etc.  The bloodwork and EKG are part of the pre-admission process right before you have surgery, which would make the test results you have already had done pretty old by then.  The Seminar / Informational Meeting is required before you start the process, just like most other centers.  I know there is one tomorrow (Thursday) if you want to check it out.  My friend Alan, who's lost over 100# since January, is speaking at the seminar.   I hope you'll have success appealing their decision and Dr. Loggins will be able to persuade them to approve you.  I'll keep you in my prayers.   Keep us posted. Blessings, Yvonne

I'm the Kim H that just had surgery with Dr. Cobean, and he is truly and excellent surgeon. The MMC bariatric clinic was wonderful. Traveling from Presque Isle was a bit of a pain, but Dr. Cobean's expertise with my particular type of surgery (revision) was worth it. I had my first appointment with Dr. Cobean on May 1 and my surgery was 10/22, so about 5 1/2 months total. That is shorter than some, but I had already gone through the entire pre-op process with a local surgeon before he decided he wasn't comfortable with doing the surgery himself. I agree with everyone that the worst thing you can do at this point is give up. You have a number of options open to you. I worked in healthcare for over 15 years before turning to the education field and I can tell you that the hospital administrations #1 priority is money. If they can bully you into thinking that you have no choices, they win. My local hospital is affiliated with EMMC in Bangor, but I was referred to MMC in Portland specifically for the surgeon's ability and I had no problem. If I were in your shoes I think I would probably write a letter to the medical director explaining your situation and, if you truly want to continue with Dr. Loggins, explain to the medical director that if it can't be approved you will have no choice but to change your PCP and have all of your healthcare needs met by CMMC instead. That way you hit them where it hurts because they are not losing just the income from one surgery, but income from healthcare needs of, probably, an entire family. I am not saying that you will need to do that, I know what it is like to find a PCP that you really like and how hard it can be to find a new one, but sometimes the threat is all it takes. This may sound underhanded, but I don't think it is anymore underhanded then what they have already done to you. Please email me personally if I can be of any more help, and like the others I would absolutely LOVE to babysit for you. I'm guessing you might not want to put thoses babies on a bus and send them North, so I guess I will just say, If you ever find yourself in Presque Isle and in need of a break....GIVE ME A CALL!!

Thanks!  Ya know---I have a friend in Madawaska and we rode the ATV all the way to presque isle from there-----I may just drop those babies off afterall for a break ha ha! So here is my update.  So I called to find out if I should appeal or what---and Dr. Loggins got on the phone himself.  I couldn't believe it.  He was shoacked that they told me I could not go their because they were a competitor.  He was as disgusted as I was it seemed.  He has talked to some vp's there and are working on some things on his ens.  I think it is 'the bigger picture' though.  Like---that is a lot of people being denied care if they have this rule etc. So on my end I called the first lady I talked to at St. Mary's and she had a few things for me to try.  There is the girl in HR that would handle all these.  Option A) Appeal to this lady for a referral exception because of my cir****tances and access to care.  B)  I could upgrade my HMO plan with them to one where I can go to any harvard pilgrim doctor.  The plan says I can see Dr.  Loggins---but I am not allowed to use CMMC as a facility.  So I would need to pose her with this question....what if I had this plan and could see Dr.  Loggins.  I go through the entire process  with him---then what since he does not have priveldges at St.  Mary's.  Just waste all their money for 6 months in the process and not be able to have the surgery because it would be at cmmc?? Could I get a special exception for the surgery to use the facility? (this is a good one I think.--although it stinks that the plan would cost more---pay less %---but still worth it in the end.)  Final shot would be to go to a new doc---which I would have a hard time doing anyways. I left her a message and hopefully she will call me back--although I bet monday. I will keep you posted.  I really hope I can have an exception with my plan---or get an exception just for the surgery facility with a new plan.