The "Gate Keeper" for Dr. Stewart

Tracy
on 12/14/10 2:27 am - Arlington, TX

Thanks everyone for the advice. Yes, I wish I could say I found my policy does cover it so I could shove it in her face but unfortunately, no, she is right. As I said, we were just bought out around the time I made the appointment so I told her I had no papers for the new company yet and thought that I would have received them way before the appointment. But to the guy who said I shouldn't depend on the doctors office, you are right. Quite irresponsible of me to believe someone who said they would let me know. I should have looked it up myself and then I wouldn't have been so dissapointed. Yesterday I was frantic and emailed HR, then called the insurance company. I was told the exclusion is also there for 2011 but they didn't have the papers to send me yet. So I am over it, and now just trying to figure out how to get hubby taken care of. Even if we can only afford the sleeve, it is better then the crapband for him. Depending on how we are treated today, we will see if we will go with Dr. S. I will be telling him about this "woman". Oh and yes, she is the intake person, not a receptionist. She told us during the seminar that she would call our insurance weeks in advance and that we should be expecting to hear from her at least 2 weeks prior to the appointment. Lesson learned.

Lapband 3/1/05
Lost 120 lbs-gained 50lbs back
Sleeved 6/2/09-Lost 20lbs gained it back after hysterectomy on 1/15/10

As of 11/7/2015 I have gained all my weight plus some. I weigh 313lbs. I blame it on steroid injections I received for my back, the cymbalta i am on for fibromyalgia, I was on Lyrica for 3 months and gained 30lbs, and I found out I have Hashimoto's thyroiditis as well as Pcos. I had back surgery and had to lay flat for three months which didn't help either only to find out a year later the surgery was a failure. I now have a spinal cord injury and I am in a wheelchair! So much has happened since I last visited this site. The only thing I can do is swim. I am going to try and do this at least 2 times a week and work up to more!

Mommy2006
on 12/14/10 4:56 am

DS on 09/14/10

I really dislike receptionists like that. (Or whatever they are.)

I LOVE LOVE LOVE my primary care physician and the nurses. I dislike immensely the woman who primarily answers the phone and staffs the desk. She is curt, rude, at times clueless, and just annoying. I have almost changed doctors because of it, which is a pity because I REALLY like my physician.

Do you ever wonder if doctors do that on purpose?

I hope you guys figure out a way to get your insurance to cover it. I don't think insurance should be allowed to exclude WLS. *hugs*

kj80230
on 12/14/10 5:45 am

DS on 07/28/10

Tracy,
Hang in there, it is disappointing to hear that insurance won't be able to help you out but Dr. Stewart is a wonderful surgeon. I will agree that I have found that you have to follow up with this person fairly regularly to get what you need but I am willing to do that. Good luck! Kj

~Kj ~ My

is Betty (bldeck) 277/268/174/150

Lab Rat Data HW/SW/CW/GW

Tracy
on 12/14/10 9:34 am - Arlington, TX

VSG on 06/02/09

Well we came back from the appointment. I am again impressed with the doctor. I loved the other staff person, not sure who it was, that did my husbands EKG. But still not fond of the "woman". Oh well, I guess her personality rubs people the wrong way. For me I can pick "Fake" out of a crowd. Just saying.

Dr. Stewart said he wasn't sure how much he would charge for just the switch portion of the surgery for me. (We did talk about me even though the appointment was just for hubby, I thought that was nice). He finally said possibly $17,000 because he said the hospital stay would be the same, he wouldn't use a certain type of staple, etc. For hubby it will be the $22,000. Anyone have a money tree they can let me pick?

I have decided that my hubby needs this more than I do so we are going to try and see what we can do. We know getting a loan is an option. I just HATE the fact that our company excluded WLS. It just really ****** me off and I am not the type to just lay down and take it even if there isn't much I can do. Hubby says I have been spitting fire all day today lol. I keep saying "It just ain't right!" and yes I know it is bad grammer but when I am mad the Texas accent comes out!

Lapband 3/1/05
Lost 120 lbs-gained 50lbs back
Sleeved 6/2/09-Lost 20lbs gained it back after hysterectomy on 1/15/10

As of 11/7/2015 I have gained all my weight plus some. I weigh 313lbs. I blame it on steroid injections I received for my back, the cymbalta i am on for fibromyalgia, I was on Lyrica for 3 months and gained 30lbs, and I found out I have Hashimoto's thyroiditis as well as Pcos. I had back surgery and had to lay flat for three months which didn't help either only to find out a year later the surgery was a failure. I now have a spinal cord injury and I am in a wheelchair! So much has happened since I last visited this site. The only thing I can do is swim. I am going to try and do this at least 2 times a week and work up to more!

P. Poster
on 12/14/10 9:46 am

Can one of you pick up a part time job at Starbucks? They offer full benefits to part timers, and their health insurance is AWESOME and covers the DS. Just a tip :)

(deactivated member)
on 12/14/10 9:49 am

I was self pay with Dr. Stewart. I got a loan from the bank for my surgery, and put my anesthesia on a credit card, as well as my travel and hotel expenses. There's also www.surgeryloans.com that Dr. Stewart's office works with, but the interest rates are SKY HIGH! They do not work with Care Credit, however. Yes, sometimes said employee is difficult to deal with. I'm sorry you had to deal with that before you even got to see the doctor. Here's a positive note: if you end up self paying.....you can deduct it on your taxes!!!

jewel506
on 12/14/10 11:54 am - Houston, TX

DS on 05/26/10

I seem to be in the minority - but I had NO problems with this woman. She was nice to me all through the process (I was self-pay) and always very helpful. i just got "lucky"? :-)

Dr. Stewart is FABULOUS!! Even if you have to deal with this other person - he is worth it!!!

Hope you can get your finances worked out so your DH can proceed.

Best of luck to you both on your journey(s)!!

Julie

“Be kind, for everyone you meet is fighting a hard battle.” - Plato
Stormy 918 is my Angel Angel to DarcyMad, MizCharlotte, kmg9122, Staceeann & dianeys73/Diane Davis
HW 258.5 /SW 250 /GW 140 /CW 125

stormy D.
on 12/14/10 11:36 pm - spring hill, FL

DS on 07/13/09

Umm.... I have no problem saying her name. I assume you are talking about Leah! I can so feel your pain. I had similar expereinces (notice the plural) throughout the long and drawn out process of my insurance appeal and finally the surgery. Hang in there. Putting up with her is a PIA but in the end she is just a tiny hurdle to overcome. I don't understand how she still has a job there!
Best of luck to you and your hubby.
Stormy

Yesterday is history,Tomorrow is a mystery, Today is a gift
That is why it is called the present.

(deactivated member)
on 12/15/10 12:41 am - San Jose, CA

DS on 08/05/03

One more thing: you need to find out whether your insurance plan is fully funded or self-funded. If it is fully funded (which means your company pays the insurance company a big sum each month for insurance, out of which the insurance company pays all the bills), then the exclusion is likely iron-clad. However, if your plan is self-funded, your employer is just paying the insurance company a much smaller fee to ADMINISTER your insurance plan (using the rules the insurance company already wrote, and the contracts -- and contract prices -- the insurance company already has with doctors, hospitals, etc.), but your company actually pays the doctors, hospitals, labs, etc. In that case, if you appeal, your final appeal is to your company -- and you can ask them for an exception to their WLS exclusion, because it is up to them whether or not to pay. You can argue to the company that it will make more financial sense to keep their employees healthy by covering the surgery.

It's a long shot, but don't leave that stone unturned, just in case.

(deactivated member)
on 12/15/10 1:04 am

DS on 12/16/09

I am a patient, not a spokesperson for Dr. Stewart's office, but I spoke with Matt Le Beff, Dr. Stewart's marketing director, in person yesterday about this very thread and several others recently. They don't monitor OH like hawks and don't want to, but are aware of a lot of the dissatisfaction with staff (said person in particular).

Here's the bottom line. She is a bear with insurance companies and is the best patient advocate when it comes to getting approvals. That is her forte. Her personal skills may be lacking and I personally think her job description is too broad, but when it comes to doing what her intended job is she is awesome.

Any self-pay patients fall outside of that realm (as did my wife and I). So, while it's not my job or place to make excuses for her, I am very sorry for your experience with her and hope you can look beyond this issue. Dr. Stewart is the best in Texas when it comes to DS and I could recommend no other surgeon above him. It is his livelihood and he cannot extend credit. His competitor 30-some-odd miles down the road has a monthly advertising budget of $150,000 and the only way to compete, besides his obvious experience, is to knuckle down and push ahead and advertise. Trust me when I say he's working on staff issues. For me, however, it will always be about numbers and experience first -- not who has the prettiest website, most polite staff, nicest bedside manner or the most billboards. In the end it's all about a smooth intraoperative and postoperative course. My skinny ass will eventually get over the rest (pun intended).

I hope all works out for you and your husband and you're able to look past this issue. You'll get the absolute best medical care available from Dr. Stewart.

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The "Gate Keeper" for Dr. Stewart