Is it pretty typical to have to submit all your own insurance items?

PlanetJanet
on 9/2/11 12:13 am
I just met with the surgeon yesterday.  I loved the surgeon, but wasn't wild about the bariatric coordinator or the office in general. I guess I wanted to just "talk it out" a bit here to see if my concern are valid or if I'm just not being realisitic in expectations. 

First, I am likely going to get the sleeve.   All of their materials said lap-band and gatric bypass.  Like, all the forms I had to sign referred to the band and the RNY.   I know the sleeve is a newer procedure, but it really turned me off that they hadn't updated their forms to include all the surgeries they offer.

Second, before my appointment they had me call my insurance company and find out what they cover - and fill out of form explaining coverage.  I had no problem with this, and I think every patient should take responsibility for knowing what is covered by their insurance plan.  I got the name of a rep who said I needed 6 months of diets - and it would have to be documented. I asked her if receipts from a meal delivery diet service would suffice and she said "yes".  So I collected receipts and put together this tidy little 6-months of diet "proof" that I thought might work.   Well, the coordinator wouldn't even take it and said that I needed to fax that to the insurance company myself.  Is that normal?  I don't mind doing some legwork, but I thought that the submission would ultimately come from my doctor's office.

Now, I really connected with the surgeon and I think he would be great.  But, I am not totally sure that this place is the right place for me.

There is another surgeon that is a bit closer to me.  He has a very active support group (which he attends himself), a great hospital, etc.  This could be a "grass is always greener" situation.

My husband thinks I should go check out this other place.  I feel bad, like I'm jerking around this first surgeon to go to this first appointment and then change my mind about him --  but, really, I don't think he'll be up at night worrying about it. LOL! 

The monthly support groups for surgeon A are about 1 1/2 hour drive for me.  Monthly support groups (acutally happen twice monthly) for surgeon B are 50 minutes away. 

I guess I just need some help in thinking this all out.  Would you be turned off by the forms not being  updated to include the sleeve, or is that just being petty and silly?  Is it unusal for the patient to need to fax the insurance info in themselves, or is that typical?

Thanks for any thoughts, and for reading all this rambling.

katsparks
on 9/2/11 3:05 am - Auburn, CA
I would check out the other surgeon. I honestly relied heavily on my surgeons support staff for help through the insurance approval process. They should have someone who helps you. You are not a surgery coordinator, you do not know how to submit preauthorizations to insurance companies. I agree with the feeling that the doctors office should have updated the paperwork to show all surgeries that he is offering.
I can say honestly that support group meeting after surgery are essential. Statistically, people who go to support groups have better long term results. It is helpful to meet with a group of people who are dealing with all of the same issues that you have. I think that it is awesome that at the other group, the surgeon participates. That shows me that he truly cares about his patients.
If it were me, I would check out the other surgeon. Remember that you will be dealing with support staff more that the actual surgeon so the lastthing that you want or need is a crappy support staff. DO NOT FEEL OBLIGATED to go to this first surgeon. You had a consultation. It is to decide if you would like to go with that doctor or not. I interviewed 4 plastic surgeons before I decided on who I was going with. All of my surgeons knew that I was having multiple consults and they commended me for educating myself. This is your body....get the 2nd surgeon a try.

Good Luck!
                                   
SW:270         GW: 125         CW:104(and still losing)
New Goal Weight: Whereever my body feels most comfortable and stops losing.

Abdominoplasty with Dr. Scott Green: 10/11/11
Kayla B.
on 9/2/11 8:02 am - Austin, TX
You're a paying customer, it is perfectly reasonable to interview more than one doctor.
5'9.5" | HW: 368 | SW: 353 | CW: 155 +/- 5 lbs | Angel to kkanne
http://i20.photobucket.com/albums/b224/icyprincess77/beforefront-1-1.jpg?t=1247239033http://s20.photobucket.com/albums/b224/icyprincess77/th_CIMG39903mini.jpg  
Emily F.
on 9/2/11 9:39 am
Well, first red flag is how many sleeves have they done if they don't even have it on the paperwork???

Of course, you should interview more than one doctor.
PlanetJanet
on 9/2/11 2:32 pm
Thanks for your responses - I really appreciate it!  I am now signed up to attend a seminiar for surgeon #2.  Assuming that goes well, I'll make an appointment for a consult.  You all are totally right - a second opinion is a good idea, especially if my guts are telling me that something doesn't feel right with the first office.

Thanks again! 


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