No surgery for me
Ms. Cal Culator
on 9/13/11 1:29 pm - Tuvalu
on 9/13/11 1:29 pm - Tuvalu
On September 13, 2011 at 3:37 PM Pacific Time, Everchanging wrote:
Hi my fellow vsg board members,I'll try to make this as short as possible.After my consult with the gastroenlogist(sp??) about doing my upper gi which is tomorrow.On my way home i stop by my pcp office for him to write my letter and to fill out the paper that my ins required.My Ins require that i do some kind of program for six month and I've been doing WW since march and my pcp knew this.So i told him that i would need to come to him once a month for six month.Well he told me that he wasn't going to do that,So he told me just to continue doing what i was doing and keep accurate documentation and he would look over everything and fill in the blank on whatever paper work i needed.Well when i was in his office he told me that he could not fill out my paper work because he had not seen on a month to month bases and that totally made me mad because that's not what he told me in march.If i knew that he was going to change his mind i would have went to another pcp.So i called my surgeons office and spoke to the MA and she told me to get a new PCP because the letter that he faxed over to them will get me denied and the fact that he don't wanna fill out the paper is not going to work in my favor.
So I've done everything and now i have to do another six month of a supervised diet,I already found a new pcp and i will have my first appointment with him on the 21st and I'll explain everything to him when i go.So Feb 2012 will be my last month and then i can submit everything to my Ins,Thank god that everything I've done so far is still valid for a year.I'm bummed that i wont be getting my surgery towards the end of this month
but i know that everything happens for a reason.I know that everything is in god hands and will be on the loser bench before i can even blink and eye.I just wanted to come and update you guys on what was going on with me.-Pam
Okay...I don't know how it works in NY, but in CA, we appeal within the insurance and then to the state. In CA the state consistently overturns that 6-month thing.
But only if people appeal.
You need to figure out what YOUR policy says about appeals nd then what YOUR state says.
BTW, the insurance company is COUNTING ON your giving up and going away. Do you really want to make them that happy?
Oh trust im not giving up,This is just a minor bump in my journey.The thing is even the letter that my former pcp wrote wasn't good enough.When i called my surgeons office his MA told me that the letter was really weak and it was only three sentence and that even if he didnt fill out the paper work for the 6 months if i had a strong letter from him it might help.All i have is all my eval and a weak letter thats why im going to another pcp.These are dr that my surgeon work with in case you dont have a pcp.
Pam,
I'm so sorry you're going through this! I had this happen to me before too. I did the entire 6 month diet only to have the insurance tell me it wasn't documented well enough. My pcp basically told me "oh well". I was furious! So now I'm doing it all again. :( I'll be done in like January '12...we can be buddies. 
I'll be watching for updates!
Rebecca
Perseverance will pay off in the end.
I'm in Canada, and surgery is elective, but covered if referred. However the waiting list has 2000 people on it, and they only do about 70 surgeries a year. There is a primary list of 500, and people with diabetes and heart disease constantly fill those spots. I have neither disease.
I was forever placed on the secondary list indefinitely. I waited 12 years, and relocated to another province 5 hours away from home.
I had my surgery on June 23, 2011. Original referral was sent in February 1999. It was a long, hard road -- but I've been sleeved!!!
It still feels surreal to me.
You have to advocate for your own health. Scream, cry, complain, fight, never give up.
Just keep hanging on.
I've come to find out.. that maybe that 12 year wait was a blessing in disguise. Like that song, thank God for unanswered prayers... The surgeon in my hometown has had many patients with severe complications from mistakes he has made.
My surgeon was top notch! I owe him my life.
Hopefully your new family doctor will be on board with your decision, and do everything in their power to move things along as swiftly as possible : )
All the best to you!
I'm in Canada, and surgery is elective, but covered if referred. However the waiting list has 2000 people on it, and they only do about 70 surgeries a year. There is a primary list of 500, and people with diabetes and heart disease constantly fill those spots. I have neither disease.
I was forever placed on the secondary list indefinitely. I waited 12 years, and relocated to another province 5 hours away from home.
I had my surgery on June 23, 2011. Original referral was sent in February 1999. It was a long, hard road -- but I've been sleeved!!!
It still feels surreal to me.
You have to advocate for your own health. Scream, cry, complain, fight, never give up.
Just keep hanging on.
I've come to find out.. that maybe that 12 year wait was a blessing in disguise. Like that song, thank God for unanswered prayers... The surgeon in my hometown has had many patients with severe complications from mistakes he has made.
My surgeon was top notch! I owe him my life.
Hopefully your new family doctor will be on board with your decision, and do everything in their power to move things along as swiftly as possible : )
All the best to you!
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