One Small Step Forward - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

OsoDelDesierto · 12-07-2006, 11:55 PM

I had my appointment with my PCP this morning. He gave me a referral to a bariatric surgeon with no fuss whatsoever, which did not surprise me, since he had encouraged me to consider WLS a year-and-a-half ago. What did surprise me was that he referred me to a local surgeon, Dr. Monte Schwartz, whom I did not think was one of PacifiCare's providers.

In my preliminary research, I had found positive information about Dr. Schwartz and read good reviews written by his patients, but he was not listed in my new 2007 PacifiCare FEHB provider directory. I was expecting to have to go to Dr. Hilario Juarez in Phoenix, almost two hours away, because he appeared to be the only bariatric surgeon listed in my directory. Dr. Juarez has a great deal of experience and mostly glowing online patient reviews, and a good friend had her very successful WLS with him, but I wasn't thrilled about the prospect of having to deal with the travel as an added issue with the WLS and being so far from my surgeon and his aftercare program post-op.

When I called to make my appointment with the bariatric surgeon, I explained that I had been referred by my PCP. The receptionist asked for my insurance info, and I explained that it was PacifiCare. When I mentioned that the PCP's referral letterhead said PacifiCare Secure Horizons, she stated that they couldn't accept me as a patient with that type of PacifiCare insurance, and that they might have to send me to Phoenix.

Fortunately, I took out and looked at my insurance card, which said PacifiCare Signature Value, and told the receptionist that my card didn't match the referral letterhead from my PCP. She said the card information was what was important and that my PacifiCare Signature Value plan was no problem, and then she scheduled me for an appointment in January with the surgeon's RN/Clinical Coordinator of Bariatric Services. Yeee haw!

I am hopeful that my insurance will indeed cover Dr. Schwartz. Although he has been practicing for less time and has not done as many surgeries as Dr. Juarez, he has excellent training and credentials and has done almost 500 RNY GBPs, plus many other abdominal surgeries as well. I would definitely prefer to have the surgery here in Tucson and be able to participate in the aftercare program.

I know that this is just one small step in my WLS process, but it is a step in the right direction and I am delighted!

Gini · 12-08-2006, 12:16 AM

I so know the feeling. I thought I was going to have to travel as well. The dr in Frankfurt is more experienced and glowing reviews as well, but he was 2 hrs from me. I was later informed that there was one only 45 mins from me that was newly added to my plan. I had my appt with him yesterday and it went very well. I was comfy with him, as was my hubby. He answered my questions and was very knowledgable. So I know how you feel. I wish you the best of luck.

ladytonya · 12-08-2006, 08:08 AM

Good luck to you! I have to travel 3 hours for my surgery. The local doctors who do the surgery won't operate on anyone who is over 400 lbs. Stupid! I was like so what, you're telling me I'm too fat to have WLS? Whatever! I found the next two closest doctors and called both. The first one was only a little more than an hour away but I was extremely unimpressed by their office. The people there were extremely rude! Both my local surgeon and the one an hour away are not WLS specialists. They are both part of general surgical practices and have only done a relatively small number of WLS. The surgeon who I went with only does WLS. Heck, the name of his practice is Carolina Weight Loss Surgery! I am very happy with him. I will have to travel for follow-up appointments, but I have found a local support group that I am planning on attending. There are many people in the support group who have had surgery with many different doctors. For the sake of safety, I'm glad I'm having surgery by someone who has done thousands and not just a few hundred!

OsoDelDesierto · 12-08-2006, 09:22 PM

Thank you, Gini and Tonya, for the words of support and encouragement!

shereeks · 12-09-2006, 06:45 AM

Good luck! Every bit of hard work and pain is worth it in the end! Remember, life is worth it!

Hunnyblonde · 12-09-2006, 07:30 AM

Congratulations on an encouraging beginning to your journey. Hang on though, cause once the ride starts it moves pretty fast in some areas and slooooooowws way down in others. Any way you put, it's a wild ride.

Tonya, the fact that your local surgeons don't operate on people over 400 is not about you, it's about them. From what I understand, you have to have done a certain number of wls and have some advanced training due to the extra complications that could arise during surgery. My surgeon can't operate on 400+ either. So it's not won't, it's can't. Feel encouraged that these precautions are in place--they're for your safety. And, congratulations on your re-birthday in just a few days!!! You loser!

jackson · 12-09-2006, 07:52 AM

Good stuff mate, one small step or one giant leap its all about moving in the right direction , I look fowards to hearing of your progress in your WL journey. If its any consolation my Surgeon is a two hour drive away , its a small price to pay in the bigger picture, never the less it is ultimatly you who has to be confident in your practitioner.

ladytonya · 12-09-2006, 01:31 PM

Rene, I ultimately realized that about the local surgeons. I was depressed for months and it delayed me ultimately finding another doctor and getting my surgery almost two years. What angered me what the fact that they just said they couldn't do the surgery on me and gave me no other options. They didn't offer assistance in losing the 44 lbs. that I would have had to lose at that time to get to 400 and they didn't tell me that it was just them but that other surgeons were able to operate on heavier people. Wnen I told them that I had read about much heavier people having the surgery, the nurse there told me that was the exception rather than the rule and if someone what was much heavier like that was having surgery it was probably being done outside of that United States. Now, of course, I know that's not true. I am two days away from my surgery and couldn't be happier with the surgeon I ultimately chose!

LyndasRoom · 12-09-2006, 01:57 PM

I have Pacificare Signature Value as my insurance provider. With the exception of a lab bill which made it's way to me accidentally, I haven't even seen bills from my surgery in July. It has been great! I wish you luck on this amazing journey!

Tim · 12-09-2006, 07:53 PM

I to have to travel about 3 1/2 hrs to my doc. Social Security won't cover the one only 1 1/2 hrs away I have Blue Cross ppo and if SC won't cover it they won't. Also I have to go over a pass and thru Glacier Nat. Park in the winter here in northern Montana. So I know there will be tough roads but like you folks say the journey is worth it. Tim