Health Insurance and Finding a Surgeon

I've had a lot of health issues in the last ten years, not only the ones already mentioned but also depression, insomnia, migraines, unspecificied stomach issues, and a lot more. As the song says, I'm much too young to feel this damn old. I've gotten used to calling doctors and insurance companies, saving copies of things, filing appeals and the like. My advice is: document, document, document. Save everything until you have the statement showing $0.00 in your hand, then have a shredding party.

I haven't been working full-time for a couple of months, so I am dealing with my spouse's insurance on this procedure. They were taken aback to find out they were my primary insurance, so that had to be verified recently. Then they told me the only bariatric surgery provider they covered was over 50 miles away. I watched a web seminar on his site and went to the initial appointment, thinking his practice was my only option unless I was going to self-pay.

Well, I didn't like the doctor. He wasn't listening at all, he didn't bother looking at my medical records, and he was ready to run a bunch of tests I'd had in the last couple of years when the results were present in the medical records he wasn't looking at. He was extremely dismissive. In effect, he said, "We do the surgery, we make you sick if you eat ice cream, you get thin, end of story. Bye bye." That approach did not do it for me.

I had recently read about another facility in the newspaper who had gotten some positive attention for their standards in minimally invasive and cutting edge weight-loss surgeries. They happened to be more conveniently located. My husband and I went to their free seminar, and it was fantastic. It was interactive, informative...I took pages of notes and was ready to sign anything and go to work for them, too, if they'd let me. The bedside manner of the doctors was like night and day from the previous surgeon. This particular facility emphasizes nutritional classes, follow-up care, nutritional coaching, support groups if you choose to participate in them, etc. I was really excited by their approach, because it actually sounds like it can work. They gave us information on how to finance surgery if insurance would not pay and that was that. Imagine my surprise when they told me they were a contracted provider with my husband's insurance! Glad I asked!

I then went to retrieve my medical records from the first bariatric surgeon--there were about 600 pages of them, so I was grateful not to have to accrue them all again. It also made it much easier to fill out the new facility's application accurately--they want every bit of medical history and then some. My intake appointment, as they call it, involved meeting with a lady who does billing and is the liaison with the insurance, and then a consultation with the surgeon. A lot of it was review from the seminar and other research I've done.

The surgeon I met with recommended gastric bypass for me because I have "what they call" classic metabolic syndrome, where I gain all my weight in the torso, also known as the apple body type or, as I once heard it explained, "egg on stilts look." (Apparently, there is a connection between which bariatric surgery might achieve optimum results for each specific body type.) I asked him if PCOS was still present when there were no longer ovaries, and he said, "That's a really great question!" I don't know if anyone knows that answer.

My particular insurance wants 6 months of a physician-supervised diet, two years of chart notes at a certain weight and BMI, the psych eval, the nutritional assessment, and a monthly visit to check in with the nutritionist. There are nutrition classes prior to surgery and after it.

Another thing I like about this facility is that they call the providers to find out what your benefits are initially, instead of you doing that. It sets a precedent with insurance, and a good one--insurance is always going to be more attentive to the provider. Still, you have to be loud if you want anyone to listen to you at ALL. Loud, persistent, with your headache cure of choice at the ready.