Frustrated already with the WLS center - ThinnerTimes

jenn75 · 07-17-2008, 04:20 PM

So, all I have done with the center is go to their informational seminar, and already they have me utterly confused, and thus frustrated.

A) At their informational seminar, their literature clearly states that I can either attend their 6 month nutritional lifestyle classes as the 6 month supervised diet, OR I can choose to do this with my PCP. It also says that after my third visit with my PCP, I can schedule a visit with a surgeon.

B) I have already been doing a supervised weight loss with my PCP, and just went for my third visit with her on Monday. She asked me to get the forms needed for her to document what she's done with me thus far from the WLS center.

So, I scheduled a visit with a surgeon since I just had my third PCP visit. Then I called back to ask when I would receive the forms my PCP would need to fill out documenting my supervised diet. The lady then told me that my appointment with surgeon should not have been scheduled, and that I needed to do their 6 month lifestyle classes. At that time, I said "I thought I had a choice, either their classes or do it with my PCP", and explained how I'd already been seeing my PCP. She said, oh, ok, well, you will need to come to one of our lifestyle classes and pay $145 and you will get all of the forms your PCP needs then. Fine, so I sign up for the damn class.

So I get in the mail today the damn form that my PCP needs to fill out for each visit. So why am I paying $145 to go to this one class?????

I think I'm at the point where I'd like my PCP's office to find out exactly what I need to do and can do, because I keep getting a lot of mixed messages. I definitely don't want to miss a step, but damnit, I'm already sick of this place, and I haven't even had an appointment there yet! Sadly, they're one of two places I can go that my insurance will pay 100% in my area for. Plus, they are very good surgeons. But really, I'm at a loss for words here.

GrandmaRose · 07-17-2008, 06:37 PM

Jenn: Stay with it. It takes perseverance. I met all my surgeon's requirements, only to be told that I hadn't met my insurance ones. That took another 8 months!

After the surgery - you will need the same perseverance to stay on track. So this is good preparation for you. You need to chase down your own information. Don't count on anyone else to do it for you. Make sure you meet your insurance requirements. Then ask your bariatric or surgery center to mail you their information package - or go online and see if it is there. That way you will have their requirements in writing. All of this takes time. they are sort -of testing us for compliance, too, I think. To see if we can stick with it.

Don't give up. A lot of us had to aggressively go for this. Be patient. this will affect the rest of your life.

GrandmaRose

Lap RNY 05/08/08

BabyNicole · 07-17-2008, 07:09 PM

I sorta know how you feel. The insurance lady at my surgeon's was driving me crazy (and I'm sure I was driving her crazy too). But, don't let the staff deter you from a place. Remember, it's the surgeons that you want to be phenomenal .

Of course, it helps when the staff is great too, but you can't have everything! LOL Hang in there. Oh, and if you got the papers in the mail, why not cancel the class and get your money back?

Sue0609 · 07-17-2008, 07:26 PM

I had to pay $500 for counseling and other related fees even though my insurance required none of it. That's the price of admission. My docs are famous (as far as WLS docs go), they can dictate whatever requirements they want. But I believe them when they say that sticking with their pre-op requirements is nothing compared to what is expected of you post-op.

It's a PITA, yes. But if they are good it is worth it, IMO.

BabyNicole · 07-17-2008, 08:29 PM

Quote:

Originally Posted by Sue0609

I had to pay $500 for counseling and other related fees even though my insurance required none of it. That's the price of admission. My docs are famous (as far as WLS docs go), they can dictate whatever requirements they want. But I believe them when they say that sticking with their pre-op requirements is nothing compared to what is expected of you post-op.

It's a PITA, yes. But if they are good it is worth it, IMO.

I had to pay for the NUT and Psych too. I got reimbursed some from my ins comp, but they didn't require that either. It was the surgeons that required it.

jenn75 · 07-17-2008, 09:23 PM

So what you're saying is, even though I know that the insurance may not necessarily require some things, the center themselves may want me to jump through their own set of hoops? Ok, despite that making little sense (other than they want me to be fully prepared for my new lifestyle), it actually does make sense and I can actually rest with this in mind.

So perhaps I should just suck it up and fork over the cash and go with the flow? I'm really not trying to get out of anything per say, but I don't see the need to do double the work either, or pay more than I have to if I can do the same crap with my PCP. What I really don't want to do is have to start the whole 6 months over, that is all I'm worried about. I will go to this session and see what they have to say. I'll explain where I'm at in my diet and let them know my PCP is documenting my diet stuff, but I'll pay their damn fees and perhaps they will be happy with that. I have a feeling they're still going to get the full amount from me as if I was going to their program for 6 months, from what the lady said on the phone. So, they might as well say "you have to pay us $X if you want this surgery". I can deal with that. Just don't try to tell me I have options when I really don't!

Thanks all for your feedback! I am willing to do whatever it takes before, during, and after. I know there may be days when I don't think or act like it, but this is something that I'm not willing to let slip between my fingers because of my own lack of trying.

Puddin · 07-17-2008, 09:42 PM

I don't think it's jumping through their hoops as much as making sure you're prepared for what is about to happen. I think a lot of people don't understand the drastic steps we are taking to get our eating and bodies under control. My insurance requires three months, but my surgeon requires four nutrition sessions, a month apart. They are pushing back my possible surgery dates by over a month because of it. If you have questions, I think you should call your dr's office and ask about it.

BabyNicole · 07-18-2008, 01:11 AM

Quote:

Originally Posted by jenn75

So what you're saying is, even though I know that the insurance may not necessarily require some things, the center themselves may want me to jump through their own set of hoops? Ok, despite that making little sense (other than they want me to be fully prepared for my new lifestyle), it actually does make sense and I can actually rest with this in mind.

So perhaps I should just suck it up and fork over the cash and go with the flow? I'm really not trying to get out of anything per say, but I don't see the need to do double the work either, or pay more than I have to if I can do the same crap with my PCP. What I really don't want to do is have to start the whole 6 months over, that is all I'm worried about. I will go to this session and see what they have to say. I'll explain where I'm at in my diet and let them know my PCP is documenting my diet stuff, but I'll pay their damn fees and perhaps they will be happy with that. I have a feeling they're still going to get the full amount from me as if I was going to their program for 6 months, from what the lady said on the phone. So, they might as well say "you have to pay us $X if you want this surgery". I can deal with that. Just don't try to tell me I have options when I really don't!

Thanks all for your feedback! I am willing to do whatever it takes before, during, and after. I know there may be days when I don't think or act like it, but this is something that I'm not willing to let slip between my fingers because of my own lack of trying.

I've got a question for ya...have you already been approved and/or do you have comorbities? I ask b/c your BMI is now below 40 and most insurance companies will not pay unless you have health problems with a BMI of 35-39.9.

jenn75 · 07-18-2008, 05:36 AM

Puddin - yes, you make a good point and I do appreciate their approach at preparation. I guess I didn't appreciate that they gave literature showing that you had a choice between their approach and choosing your PCP's approach. my PCP has done this with many people, so I just feel very comfortable with her guidance. but i know that the WLS center is also a center of excellence so I should also trust in them, i just don't yet because of all of the mixed info i've received thus far. it's nothing against their intent of their program.

BabyNicole - yes, I'm aware that I'm now below the 40, I have sleep apnea, as well as depression and GERD. after I lost some weight, I tried to go without my c-pap machine, hoping that perhaps the sleep apnea had corrected itself, but alas, I still have it, so I'm still wearing that lovely machine at night still

.

Sue0609 · 07-18-2008, 08:31 AM

Make sure you check your insurance. Comorbidities are meaningless with my insurance, it's all about the BMI. In my case, the surgeon needed to submit a letter saying I was morbidly obese and the surgery was appropriate for me. If my BMI was below 40 I wouldn't have been approved no matter what.