Ginger T.
Hi Everyone! I started my WLS journey on 9/1/06. I started looking into the possibility of surgery and looked up Georgetown Bariatrics on the internet. I completed their online registration information and found out when they were having informational seminars. I sent a copy of my insurance card to the office on 9/11/06. I was officially put into their system on 9/6/06. I faxed the request for a letter of medical necessity to my PCP on 9/18/06. My daughter Lyndsay and I went to the informational seminar on 9/22/06. I got the letter from my PCP on 10/5/06 and sent to the WLS doctors office. I started calling daily to see where I was in their system and if I needed to do anything to speed the process along. I was told on 10/5/06 that I was in "Clinical Screening" and the nurse had questions about my Sarcoidosis for the doctors to see if I could qualify for the Gastric Bypass instead of the Lap Band. I really want the Bypass because I am a horrible sweet and bread eater and I need the restriction and the malabsorption. The doctors are afraid that I will need to take Prednisone in the future for the Sarcoidosis and I won't be able to with the Gastric Bypass surgery. On 10/9/06, I still have not gotten a call from the office to set up my first appointment. I called them and finally got a date of 10/23/06 at 7:45 AM. (I've been in the system since 9/6/06 and just now getting a date.) I'm wondering about the doctors office and their backlog...... This is very frustrating when you call and email and don't get return calls. I finally started calling the program director directly to ask my questions and I cc'ed her on all of my emails to anyone in the office. Miraculously, I started getting called back within 24 hours and emails returned the same day! I'm a happy camper now.
10/23/06 I went to the WLS office and had my blood drawn, saw the nutritionist, saw the psychologist, had the breath/infection test, had my physical, saw a video and did several questionnaires. This appointment takes care of everything that the doctor needs to send in my file for approval to the insurance company. I have to get my PCP to change the wording on his letter to state specifically "Gastric Bypass or Lap Band Surgery". I also need to get approval letters from my cardiologist and pulmonologist for the surgery. I made appts - The soonest I can get in is 12/1/06 for the Cardiologist to do the EKG, Echocardiogram and Stress Test and 12/5/06 for the Pulmonologist to do a chest Xray and Breathing Test (due to my Sarcoidosis, I have to have their approval for the surgery).
My PCP changed the wording on my letter and faxed this to the WLS doctors office the same day. They have everything they need from me to submit my file to the insurance company. They said to give them about a week to get it all together to send to the insurance company. I started calling them and my insurance company 9 days later. The WLS insurance coordinator did not submit my file to the insurance company until 11/15/06!! It took her 3 weeks and 2 days to submit it. If there are that many going through, you would think they would hire more help.... My insurance company received my file on Thursday 11/16/06 and I was approved on 11/21/06. This was less than a week!!!!!! Yeahh!!! The insurance coordinator at the WLS office told me that her experience with my insurance was something like 7 months for approval!!! I was so worried (because I am trying to have the surgery before the end of the year and my husbands insurance changes and the deductibles go up. We have almost met our out of pocket max for this year and it will be so much better for us if I have the surgery before 12/31/06) and I tried to stay on top of things daily to make sure that everything was going through in a timely manner. The only place I can see there was a time holdup was with the insurance coordinator.
I called the insurance coordinator on 11/27/06 to tell her I was approved and could I make my appointment to see the doctor. She said that she didn't have the approval yet and couldn't do anything until she got it. When I called the insurance company they told me that they had called the WLS office and given them the approval code verbally on 11/21/06. The insurance coordinator said that she would have been the only one to have gotten that information, and no one had called her. I figure it is still on her voice messages..... She said that because they got their mail through the hospital's mail office, they usually get their mail 3-4 days late (now tell me what kind of system is that? I think I would be firing people if I couldn't get my mail daily!!!! She said that when she got the mailed approval, she would forward my information along to the surgeon's appointment coordinator and she would call me to set up the appointment. (Does anyone see a pattern here besides me???) I got my approval letter in the mail that day and faxed it to the insurance coordinator and emailed and voice mailed her to tell her that I did it. She had my approval in her hands that day. I was demanding an appointment then. I got a nasty email back to say that she had forwarded my file and there were 26 people in front of me - they would get to me as soon as possible. Well, at this point, I felt that this one person was being a jerk to me and alienating my processing and time restraints, so I sent the appointment coordinator an email. She said that she didn't have my file to do anything with it - well I was steamed then..... How could one person just get pissed off because someone was trying their hardest to get things moving and sabatoge everything??? I called her - she said that she had forwarded my file and I would have to wait for the appt. coordinator to get to it. Well I finally got a call (the next day - Nov. 28) from the appt. coordinator and she said that she had just got my file. I told her that I was not trying to be a jerk, but I am trying as hard as I can to get this surgery before the end of the year. She was great - she said that they would try very hard to help me. I asked if she had a bunch of patients that were trying to get in before the end of the year due to insurance changes and she said that I was the first one she knew of. She said they really try to accomodate people with problems and would do everything she could to help me. The doctor's all day appointment is only on Tuesdays at this office. Because I am having the Breathing Test and Chest Xray on Dec. 5 (Tues.), I am scheduled for my all day appointment on Tuesday, Dec. 12th. I have to be there at 7:15 and be there all day. I will have all of the pre-surgery tests and see the internest as well as go to the hospital and take some WLS and Post-op eating classes. The appointment coordinator was great in telling me exactly what I needed from my Cardiologist and Pulmonologist. She gave me a deadline of Dec. 8, Friday to get all of the test results and their letters to her. She will put everything together for the doctors appointment on Tuesday, Dec. 12. I should have everything I need in their hands on that day in order to schedule a surgery date. They only do Gastric Bypass Surgeries on Mondays and they are completely booked up for December. They aren't booked up for Lap Bands for the entire month and I am praying they will fit me in on one of those dates to get me in before the end of December - say a prayer for me.
I saw the Cardiologist on 12/1/06 and got his approval for the surgery. Their office faxed his consent letter, copies of the EKG and all of the test results THAT day to the WLS doctors office. They were GREAT - Way to go Dr. Qazi's office! They all want me to come in and see them when I have lost weight - they are very excited for me.
I should be able to have the Gastric Bypass surgery because my doctors have said that I could take Methotrexate or Azathioprine in place of Prednisone if I have a need to take meds. I really want the Bypass surgery instead of the Lap Band - I will find out on 12/12/06 doctors appointment if they will let me have it.
