Question:
I live in the Portland Oregon metro area, Hillsboro to be exact,
I am having problems even knowing where to start. My PCP said that I need to get a letter from my insurance before they will recommend me. I thought it was the other way around, and I am not even sure my dr will recommend me. Anyone know where to go to see a dr in this area that will help me get started with the process? Yes I have insurance...Cigna to be exact, with the open access plan — dyspatchdiva (posted on November 6, 2006)
November 6, 2006
HI... this sounds strange. Is this doctor new to you, new period, or
against WLS? Did you ask them why they need a letter from your insurance
company first? Has the doctor ever referred anyone else for WLS? The
first step is usually getting a referral to a surgical group for evaluation
for WLS. The surgeon is the one who decides whether you will qualify.
After that is done, you will have to get psychological & nutritional
evaluations, have tried other weight loss programs in the past, get preop
testing - which the surgeon can give to your doctor the list that they
would like done. The surgeon's office will try to help you get approved.
Sometimes, just a telephone conversation between doctors, does the trick.
I don't know how your insurance works, but you could try calling them and
finding out who would be the surgical group that you would be referred to.
You can always ask them what they think. Maybe they have had problems with
this dr in the past, or maybe the dr just doesn't know how it works. There
are websites that the surgeons have that have dr information on them and a
website that your doctor could visit. Also, what I found helpful, was that
I bought and checked out of the library books on WLS. These are a great
reference guide. Have kind of a game plan on how you can get yourself
started. The following ones are the ones that I bought and borrowed:
"The physician's guide to WLS", "Patient's guide to
WLS", "WLS for Dummies" (yes, it seems that they have a
Dummy book for every topic!) There are a couple of others that I don't
remember the titles to. You can do a search at this site, or Amazon or
Barnes & Noble that will have the titles. What I did was checked them
out at the library if possible and then bought the ones that I liked.
There is even a post op cookbook. So, I hope this helps and good luck to
you............
— Kari_K
November 6, 2006
Cigna is very hard to deal with. Find out exactly what they need to approve
you or you will waste a lot of time.
Mine required a history of obesity, dr visits for 6 mos, one a month, with
record of dr supplied diet and exercise plan. I eventually changed
insurance plans and got it done with another plan. I was tired of messing
with them.
— geneswife
November 7, 2006
I have NEVER heard of a doctor asking for the insurance to write them.
I would call him and tell him that it is out of the norm and your insurance
company will not do it. However, tell him that you are more than happy to
bring a copy of your insurance plan and point out to him what the
requirements are for WLS.
Good luck!
— Merredeth
November 7, 2006
Hi. The main surgery center people use in this area is the Oregon Weight
Loss Surgery/Oregon Obesity institute at Good Samaritan. They are the only
"Center of Excellence" in this area, so majority of insurance
will only approve surgery, if through them. I was self pay, but I know if
you use your insurance it can be a longer wait. The place to start is the
Obesity Institute, and their number is 503-413-7557. Good Luck. Kelly
— corbettbann
November 7, 2006
Dang Girlfriend! You are just down the street from me! Well, a bit - I'm
in Cedar Mill - hey there neighbor!
The real key here is to find out from your insurance company what their
norm is - and while you're at it, I'd ask them what they cover in regards
to bariatrics. That is hugely affected by what your employer has opted in
or out of when the insurance product was being shopped for. Size of
company plays a part, as do about 50 other issues.
It is a little wierd that your doc would want a letter from your insurance,
though. Does he/she have a good MA (medical assistant) that might be of
assistance for this whole thing? Sometimes the MA is the one who really
does all of the hard work behind the scenes!
I know lots of docs in the area - I worked in health care and grew up in
the medical community in this area, as well. I'd love to chat any time.
Feel free to email me! :)
Hope this helps a bit!
Blessings,
dina
— Dina McBride
November 7, 2006
Good luck dealing with Cigna. They are one insurance company that will do
ANYTHING to get out of paying for this procedure. Just get your PCP to
show medical necessity and then appeal it when Cigna denies it. If your
PCP insists on claiming he needs a letter from your insurance, change
PCP's. Its the other way around. Sounds like a quack that either doesn't
believe in WLS or just a plain ol idiot. Good luck!
— crystalsno
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