Thoughts about choosing surgeons ..... IMHO

I want to say that I had absolutely no problems getting my insurance to approve my surgery. As soon as they had the information, it was approved in a matter of days. I feel extremely fortunate in light of the many bio's that I have read on this site, and the problems that many of us face in getting approval. One of the things that I noticed, although it is by no means a hard and fast rule, is the larger, specifically focused bariatric practice like mine, Dr. Maguire in Ohio, or Dr. Anthone in Nebraska seem to do better in dealing with the insurance companies. They have all the information, and have a lot of experience in getting around the problems posted by the insurance companies. Dr. Maguire has full time staff that do nothing but deal with insurance companies and their problems. This is not to dismiss smaller practices, but if you have problems with your insurance company on approval, maybe you would have better luck with one of the specialized practices. I may just be loopy about this, but it rings out in many (but not all) of the bios that I read. kevin

I absolutely agree that Dr. Anthone's office is great with the insurance companies. I know that I would not have had the same ease of approval had I gone anywhere else. They worked with me despite the exclusion for DS in my policy and made it happen. Thank God for Dr. Anthone!!! Katie 24 pounds gone forever!!!

Yeah, that was another reason I decided to self-pay. The new doctor in Pensacola (Dr Lord) had been a Navy doctor up until recently, so all they had to deal with was Tri-Care. So even though his office manager came with him, they don't have the experience about what to say, how to phrase it, who to call, to get the "approval nod" we all want.

have you been approved for the ds from tri care, red hair from florida is working on it.

I basically agree ... although I totally fell through the cracks at Keshishian's office and am very unimpressed with their lack of initiative in following through with my insurance co, so this doesn't always follow. Dr. Keshishian is a well-known surgeon with a large bariatric/DS practice. I was assured that his office has a crack insurance team, but in fact all they ever did was fax Dr. Keshishian's report. Despite delays and appeals, they never faxed any of the supporting materials that I had given them (e.g., bloodwork, psych report, nutritionist report, diet history, blah, blah, blah), and they never followed up with any support. Apparently this is uncommon on their part, and it's water under the bridge, but I say all of this to underline the importance of checking and double-checking EVERYTHING, even the surgeon's office that tells you they'll handle all insurance problems for you. *You,* after all, are the one who cares most about the outcome! Alison

*hijack* Hi Alison How are you holding up? Getting ready for another busy semester???? Sharon

Alison, I couldn't agree more. I actually left that part out of my original post. I am so anal about some things, that I failed to mention that I track my information all along the way. In the original transmission of my package to the insurance company, I called Anthem one week later (I never want to seem pushy), and they said they never received it. Had I not been my own best advocate, I may have left myself waiting for months. I called my surgeons office, they verified that it had been sent, I told them that Anthem never got it, and to resend it. If it was needed I was prepared to travel to Dayton, pick up the package and hand deliver it myself. Like I say, you can really only trust that which you do yourself. kevin

Yeah, I could kick myself for not following through on my own anal hunches on this one. Ultimately, really, it was my own responsibility to do so, and I should have and didn't. Oh well ... would have, could have, should have! (That's why I went to SUCH effort with my response to my insurance co's denial *and* hired a lawyer: yes, he can construct a response based on the materials I give him, but NO ONE can constrcut the actual response *I* want but *me.* He can augment ... but my response is going to form the cornerstone . And now I'm tracking my lawyer, too. Alison

One thing more about Maguire and Anthone. These two surgeons really believe in the DS AND they are knowledgable. I know for a fact, that Dr. Anthone personally gets on the phone with insurance reviewers (physicians) and cites the facts from the published reports (his, Rabkin and Hess') to prove that the DS is superior. It's hard to argue with the truth. (Although BC tried that BS in Calif for 3 years) Laurie in So Calif.