First consultation INsurance issues:

Hi everyone I havnt been on in while been to busy with end of school year things. May 8th finally came around after a month and 1/2 of waiting to see Dr. Richards for the first time! My hubby and I had our first consultation; he approved both of us for the RNY :). The meeting was short and quick. The exam was him feeling around my tummy, I guess pressing around on my stomach.  After that he ordered normal blood tests and that was it. When the check out person came in the room she was sort of surprised and said that I had the least amount of test she had seen.    So basically they took four vials of blood and checked for vitamin deficiency and metabolism. He thought we had bluecross TN we have Bluecross MA-- (hubbys job is based out of Mass.)   He was obviously prepped wrong because he, Dr. Richards, left the room when he found out  he was telling us the wrong requirements. The insurance lady was sent in to give us the details. Obviously TN has more requirements than MA        For TN we needed to lose 10% of our body weight --- MA we dont have to lose any   For TN we needed extensive four hour psych exam--- MA none is required    their were a few other things that were diff too but those were the ones that stood out    MA is less restrictive (should have known LOL) gotta love it. Now the next step left is to our nutrition appointments (for the Vanderbilt program) and get my insurance paperwork in and get an approval date Should I ask for more tests? There was no cardiac, sleep apnea, gastro tests, nothing-- (My husband has to do the sleep apnea test) This seems so easy it’s kind of worring me , just a little. Anyone have a similar experience.

Hi Janice....     Hey hun.... I was wondering where you have been... Now I know,,,, you been busy....LOL  

  I just want to share what I know.....  That doesn't mean a whole heck of a lot and I am not a professional, so since you are ASKING I just thought I would throw my wares in the bucket.... 

  Dr. Richards is a surgeon.....   He is a board certified surgeon with a certificate of excellence...  He is also a teaching surgeon that teaches other WLS surgeons across the country....  I can only tell you this cause I did lots of research on the man for a very long time....  You should too...  I went to every WLS seminar in the area a couple of times and I ultimately decided on Dr. Richards cause it just was right for me....   I have Blue Cross Blue Shield TN and I could have went to any surgeon anywhere....  But I did my homework and research on what was right for ME and Dr. Richards was just right for me....  

  I have a lot of very good friends in the Nashville area that have many different surgeons and they are absolutely wonderful.....  They rock as a matter of fact and I wouldn't change it for the world if I could.....  

  Because Dr. Richards is a surgeon he does not enter into the room to check to see what insurance you have and what qualifications for your insurance company that there might be.... 

  He goes by your previous medical records....  If something indicates to him that you need a sleep apnea test or a psycevalution I assure you that he is gonna request those items based off of your previous medical records....  He is not dictated by Insurance requirements....  Just remember when he did your consult he probably did like 5 Gastric Bypass surgeries prior to your consult that day or the day before.....  He has a lot more on his mind than what our particular insurance company required that day because it changed from the day before.... 

  I think that you might have noticed that I or any of the others did not choose Dr. Richards for his outgoing personality or his inkling to call me up tomorrow to go play 18 holes of golf with him and his wife and lunch with them at the country club afterwards...   Nope just aint gonna happen...LOL 

  You are gonna have to be very Pro Active during this process for you and your husband....  Just ask Bob from Bama....  He learned the hard way that no one cares about you but you.....  If you are uncomfortable with your WLS surgeon decision then I beg you to go have different consults......  You have to feel good about this and trust who is doing this....  If you are not there, then you need to check out other surgeons..... If you have Gastric Bypass Surgery there is no turning back.... Please do not take this decision lightly....   I know you won't hun....   I just wanted to share with you from one Dr. Richards patience to another........  He rocks...  and I thank God every day that he shared and performed his God given talent and knowledge on me....  I can never thank him enough and guess what....  I am not even on the party guest list....LOL LOL 

Thanks Trina its nice hearing from another Dr. Richards patient, I was really excited to meet Dr. Richards after all the research I had done about him. It just disappointed me when It seemed all the ducks weren’t in a row...not due to him but I guess the staff. That made me think of other issues I probably wouldn’t have other wise. Comparing insurance companies -- I was feeling uneasy and confused because of the insurance issue. I equated more tests with careful concern. ( lol it is an insurance company) Dr Richards reminds me of a person that knows what they are doing so well that he makes it look easy.  After he walked out of  my husbands patient room I had an idea that ,unlike my primary care dr, he had a team which took care of the "paper work" so he could do his job. And the "paper work" is just something I am going to have to deal with. He saw me first and at the time didn’t know we had BlueCross MA, I made an assumption  that he had everything pertaining to us medically . When he stopped talking about insurance requirements and started answering the questions I had about how the pouch worked and what he would actually be doing he was a much better personality. I am comfortable knowing that he really is interested and well known in his work and is at ease teaching others about it. I did get that from our first meeting. I am uncomfortable about the paperwork issues though. Thanks for the advice on being proactive; this is definitely where I am going to have to be on top of it.  I am going to call Monday to make sure I understand what they had in hand when he actually saw us for our visit.  Since they mis communicated the insurance company I am going to make sure the other info is in order as well.  From here on out ...No assumptions! 

Janice,    I know what you mean about being uncomfortable about the paper work.....  At this juncture is where I was telling you about being very Pro Active.....I have a whole list of horror stories and many folks here on the board that have just as many horror stories over paper work.....  It is not exclusive to Vanderbilt....    That type of thing happens everywhere.. 

  You are right.... from here on out there are no assumptions.... 

  Are you saying that you and your husband had a consult with Dr. Richards before you have you letters of approval?  

    Imma thinking I want to handle this one question at a time to make sure that I am on the same page as you are..... 

  Just remember, what we are sharing here is helping many lurkers too.....   This is valuable....

It sounds like you are on the road now and had a good visit. Hopefully you can get insurance approval fairly quickly since you don't have to wait and do all the psch tests and such. As far as the medical tests, they really do base that on your previous medical history (and anything that comes back in your blood results). Other than blood test, the most common are sleep apnea, ekg and gallbladder ultrasound. But, if they don't think you need any of these, they don't make you go through them. Its not just standard for everyone. Trust me when I say they will check everything they need to in order to make sure you are healthy enough for surgery. They want to make sure you are healthy enough. So, he must have thought you are in pretty good health to not request those. He probably could tell by feeling your tummy you don't need a liver/gallbladder ultrasound and if you don't snore loud or have problems with sleeping/tired, than he probably didn't see a reason for the sleep test. Consider yoursefl luckly. I actually went through a lot of those tests but my cousin didn't have to go through any of them. So, it is not a bad thing it just means you are doing good health wise and they are not worried about anything. If you are concerend yourself about something nad you think you need additional test, just ask. They will do it. Now, after you get insurance approval and go for your pre-admitting test, they will usually always do an EKG and lots more blood work. So, don't think you are getting by too easy. hehe. Hoping it all works out for you and hubby.

Thanks Trina and Misty I did call and find out a little more. This paperwork thing was a big issue for me because I didn’t feel like they had all my records in hand when they I met with Dr. Richards --- the insurance mix up made me feel that way at the time but I didnt bring it up while I was there. NOt sure why...maybe it was the white coat phenomena...lost my mind when I got there. I called later when we got out of the office and did find out that my Primary didnt fax it until the previous night!   Our dr appt was at 8:30 am,, very early. I didn’t think to ask if the DR. had all our records in hand. They had our letters of recommendation, but our medical records were in a pile needing to be gone through.  Well-- that said. The program required us to fill out a form telling if we had any medical issues and check off any symptoms we were having.  The Psych evaluation required us to do the same. The Consultation visit required us to do the same. So I guess ? even though they may not of had our exact medical records they had our history. ------------------------------ I do have some issues that I want to get looked at but I guess I go through my primary dr for that?  I am having new heart palps.  and blood pressure probs.  I have been on phentermine for over two years.  I read that my insurance wouldn’t cover any heart testing  asked for if it was to check for problems caused by phentermine (anorexiaents are not covered in our health insurance) ---------------------------- I think I will ask for a sleep apnea test though. Just because it scared me when my husband said DR. R told him that two patients died because of undiagnosed sleep apneas.  (not sure of the details as Vanderbilt has several years if not a decade of doing these operations) The body cant wake itself up under the anesthesia to gasp air, so they would need to put some kind of tube in for breathing when doing the surgery.   That is two patients too many for me though...over something that is just a little test. So am going to ask for it. ---------------------------- I didn’t know about the testing after approval: for Pre admitting...that makes me feel a better. I want to make sure all bases are covered and everything works a okay before my hubby or me does this.