How long from PCP visit to surgeon submitting paperwork? - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Siren · 08-20-2006, 08:45 PM

I apologize if this has been asked already. I try to research the threads befor making a new one.

My very first appointment with my PCP is on Friday. She will set me up to meet with a surgeon from what I understand. Once I meet with the surgeon, how long before he submits the paperwork to the insurance company for approval?

Thanks!

edit: I meant the title to read "How long from 1st surgeon visit to the submittal of paperowrk".....sorry.

Ann8615 · 08-20-2006, 08:50 PM

Hi,

Excellent question. Here's my process so far: (I'm sure everyone's will be a little different). Let me apologize in advance if it is too detailed.

By the way, you might want to make your annual OB/Gyn & mammogram appointments asap if you haven't had them in over 1 year...those are the only appointments that I had to make weeks in advance due to their being so busy all the time. Fortunately, I had already scheduled those, so I seem to have gotten through all the tests and exams pretty quickly.

Mid - December, 2005 - Began thinking seriously about WLS. Weight approx. 215. Knew I would have to quit smoking before I could have the surg. & didn't want to begin the process til after quitting smoking because I was afraid I might not be able to quit the cigs!
April 3, 2006 - Quit smoking (major miracle!)
06/01/06 - Saw Primary Care Dr. (PCP) to discuss WLS and request referral for WLS consult. My weight was 224. He agreed, and did preliminary bloodwork (CBC only).
06/05/06 - Rec'd call from Insurance Co. to discuss approval for WLS consult. They were reluctant to approve consult becuase I did not have a recent (within the past 12 months) medically supervised weight loss effort that failed. Explained that I have been through J.Craig, Weight Watchers, Slim Fast, Meridia (pills), Phen-Fen (pills), Overeaters Anon, and most recently, LA Weight Loss (1 year, $2,000 and a 15 pound gain on that one, folks) Explained that I was at the end of my rope, started to cry....(not enough drama in my life?). She said she needed a detailed history of my efforts (dates, names of programs and approx results over the phone would do) and would have to discuss my case with the medical director of the insurance company. 2 hours later she called back with verbal approval for consult.
06/07/06 - Received written approval from ins. co. for WLS consult. (I don't believe anything til I see it for myself!)
06/27/06 - Attended WLS education lecture (required by Dr. Callery before consult can be scheduled). Received WLS consult registration packet (which included an assignment to write an essay on why I want WLS). I would have attended this 2 weeks earlier, but had a prior evening committment.
07/04/06 - Slipped on the smoking thing & smoked 2 cigs.
07/11/06 - Submitted WLS registration packet to Dr. Callery.
07/12/06 - Made WLS consult appt.
07/13/06 - Saw my psych, he had to make med adjustment (getting off anti-depressent Paxil) in anticipation of surgery. His thinking is that the Paxil is the cause of my weight gain (yeah, right, I've been obese since I was 20, only been on Paxil 3 years).
07/14/06 - OB/GYN annual exam. Requested test results be sent to WLS surgeon (Dr. Callery)
07/20/06 - Another psych appt. (this guy is very thorough, and since I have bi-polar disorder, it's probably a good thing.) If you're not seeing a psych on a regular basis, you will probably have only a brief psych. consult in prep for WLS, ask your surgeon to recommend someone. Psych agrees to one more appt on 08/22/06 before he will approve WLS.
07/26/06 - Attended Dr. required Dietary Education meeting.
07/31/06 - Had WLS surgery consult. They agree that the surgury will be helpful. Yay! They sent me home with Dr. orders for a boatload of blood tests, EKG, Abdominal Ultrasound, Mammogram, echo cardiogram. Because I slipped on the smoking, they also asked for a Nicotene Level, and will take another one prior to surgery.
08/04/06 - Blood tests, EKG and urinalysis done at PCP's
08/08/06 - Echo Cardiogram (fancy ultrasound for heart function)
08/09/06 - Abdominal ultrasound (to search for gallstones I guess)
08/10/06 - Mammogram. Checked with WLS website, they received all my blood work results (YAY). Expect all other test results by 08/17/06
08/17/06 - Recieved email from Dr. Callery's office - they have all test results except my psych eval (which is scheduled for 08/22). How amazing - I guessed exactly right, that they would have all the results by today!

That is the process so far. FYI, each of the test appointments took approx. 1 hours, so I was able to do them on my lunch hour, taking a little extra time for driving time).
08/22/06 - Psych approval (Yay!) He dictated the letter right in front of me, and it was way more detailed than I ever imagined it would be (well, he has been treating me for 4 years).
8/23/06 - Educational session at the Sharp Heathcare group. This will be my second educational session (first was at Dr. C's), but my insurance requires the ed. session at their group, as well as the one that Dr. C requires. What's to lose, I will only gain more info...and it is only one evening, so OK with me.
08/31/06 - Dr. C received Psych approval letter.

Here is what Dr. Callery's office is telling me to anticipate as far as dates are concerned. By:
09/07/06 (estimate) - Labs placed in chart, checked & readied for dictation (estimated duration 1 week)
09/14/06 (estimate) - Chart dictation & transcription (estimated duration 1 week)
09/21/06(estimate) - Insurance authorization preparation & mailing (estimated duration 1 week)
09/28/06(estimate) - Insurance authorization review & approval (estimated duration 1 - 6 weeks, usually about 2 weeks). As soon as Dr. receives authorization from insurance company, they will call me to schedule surgury date. I can schedule surgury anywhere from 1 - 2 weeks to 3 months from the date of my authorization. I say, bring it on, let's do it asap!!
10/01 - 10/31/06 (estimating sometime between these dates) - Pre-op visit with surgeon (the Thursday prior to my surgury) and WLS surgury. Hoping for this to be done asap.

Again, sorry for the excess detail, but you asked! When I attended the educational seminar, they gave me a handout detailing the steps and explaining that the work-up takes 2-4 months. I think a lot of it depends on what your insurance is like (PPO is faster), and how quickly you can get in for tests. I am pretty agressive, so I was able to schedule the tests right away.

Keep us posted on your journey!
ann
__________________
Ann Ramirez
San Diego, CA
Pre-Op Consult 07/31/06
224 lbs, height 5'1"
BMI 42
% of fat: 49%
Surgury Date: ASAP!!

Cinerbelle · 08-20-2006, 08:51 PM

It is different for everyone. Some of the factors that make the wait longer or shorter are:

How long all the appointments for testing take.

Some insurance companies require a 6 month supervised diet.

What the requirements are of your surgeon when it comes to support group meetings, etc. Mine required 2 support group meetings with his staff and they only held them once a month.

ETC., ETC. just for a point of reference, I had to do the 6 month supervised diet...so it took me 8 months from start to finish.

michelleJC · 08-21-2006, 06:16 AM

From start of PCP appt. to Surgery date was almost 6 years. I had to change jobs and insurance companies to get the WLS covered. Time of first surgeons appt. or informational meeting to submittal of paper work, maybe 6-8 months. Total time from meeting to surgery, 6 months. Once the approval came through, it was a piece of cake. It was jumping through all the hoops to get there that really sucked.

Cinerbelle · 08-21-2006, 08:04 AM

Quote:

Originally Posted by michelleJC

From start of PCP appt. to Surgery date was almost 6 years. I had to change jobs and insurance companies to get the WLS covered. Time of first surgeons appt. or informational meeting to submittal of paper work, maybe 6-8 months. Total time from meeting to surgery, 6 months. Once the approval came through, it was a piece of cake. It was jumping through all the hoops to get there that really sucked.

I love your new avatar Michelle!!!

witticizm · 08-21-2006, 12:42 PM

I started this process in April. I would've had my surgery done in July, but the assistant surgeon went on a two month vacation. Now I'm waiting to get my surgery date for September. I helped rush things along by scheduling my own appointments to the cardiologist, pulmonologist, sleep study, psyche evaluation and pcp. I simply called and said I needed to schedule an appointment for surgery clearance. You can't do this if you have an HMO or your surgeon insists on you seeing specific doctors. Best of luck to you in your process!

michelleJC · 08-21-2006, 08:32 PM

Thanks Cindy!!