marcus

shot down again but not giving up..

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well after completing everything required and being told to expect surgury in june the surgeon now says I need to transfer to another hospital he wont do it . I take 3 pills twice a day for my bipolar-shitzoaffective disorder and he wiont do it . At fist I brought all of this up and he said no problem. Then the hospital the transfered me to said medicare wont approve surgury with my disorder and they wont even try. I called medicare and they said its no problem . I found another hospital now thats about 75 miles away that says they can do it but I have to start the whole process over again starting with a siminar on may3rd . Im not giving up on this I need it too bad.

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Oh Marcus - that is very unfair. As someone who has struggled with mental health problems in the past, I know you must be devastated.

My surgeon believes that having issues such as these is even more reason for going ahead with the surgery. Although I do not know about your own condition, with general depression, when you lose the weight, your symptoms can become less prominent because your self esteem improves as the weight comes off.

You have the right attitude - don't give up. If you have to make that longer drive and start all over again - then do it.

I would go to the end of the earth to get my surgery because I know how important it is for my physical AND mental health.

Big Hugs

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thanks for the support . my disorder is stable I even got a letter or approval for the surgury from my pscyhiatrist. I wont give up I was really looking forward to june . It was very hard to lose the 20lbs too. now I have to do another 20lbs and 6mos . with my primary .

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oh no! Sorry to hear that... maybe talk to the new surgeon at their seminar and explain your situation and see if paperwork from the things you've just done can be faxed to their office.

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thanks for the support . my disorder is stable I even got a letter or approval for the surgury from my pscyhiatrist. I wont give up I was really looking forward to june . It was very hard to lose the 20lbs too. now I have to do another 20lbs and 6mos . with my primary .

Are you sure? I know of 2 people who switched from one surgeon to another but were still about to use their 6 month supervised diet since it was current. They shouldn't make you repeat it. I'd call on that.

Good luck! Hope things get better.

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I was told by the old hospital it would all transfer just to keep seeing the primary doctor for the diet to stay current if it took a while . The new hospital said I would need to start over . Ill let everyone know what I find out on the 3rd next month. Thanks again for all the support .

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That's what we're here for, Marcus!!! B)

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Sorry to hear that they are now telling you no, but the best thing is you are still going to fight for yourself and what you need. Maybe you will get lucky and not have to go thru the whole proces again, but if you do its OK because you know you can do. Just remember everything happens for a reason.

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Trailblazer is the fiscial intermediary for Texas. They do not pay for WLS if you have a mental illness. This is not the same as the National guidelines. As far as I can tell TrailBlazer is the only FI that will not approve WLS with mental illness. The only thing you can do is go to another state with a different FI. Each facility and doctor has a different provider number and by going to another state they will file your Medicare under their provider number. You can check this out at CMS website, go to search and enter the information. It will give you the guidelines to go by.

I live in Louisiana and had no problem with Medicare paying for my surgery. They only required a 3 month supervisted diet.

Edited by martha101452

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Sorry to hear that but your attitude is GREAT. Don't give up you are your BEST advocate =)

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Trailblazer is the fiscial intermediary for Texas. They do not pay for WLS if you have a mental illness. This is not the same as the National guidelines. As far as I can tell TrailBlazer is the only FI that will not approve WLS with mental illness. The only thing you can do is go to another state with a different FI. Each facility and doctor has a different provider number and by going to another state they will file your Medicare under their provider number. You can check this out at CMS website, go to search and enter the information. It will give you the guidelines to go by.

I live in Louisiana and had no problem with Medicare paying for my surgery. They only required a 3 month supervisted diet.

trailblazer does cover with a mental illness . I called them they sent me this

Preoperative Psychological/Psychiatric Evaluation

An objective examination by a mental health professional (psychiatrist or psychologist) experienced in the evaluation and management of bariatric surgery candidates to exclude patients who are unable to personally provide informed consent, who are unable to comply with a reasonable pre- and postoperative regimen or who have a significant risk of postoperative decompensation is recommended. Such evaluation is a Medicare-covered service. A diagnostic session is appropriate and treatment sessions are appropriate if the patient has a diagnosable disorder that is likely to respond to psychotherapy. The mental health professional, the surgeon and the patient should be in agreement that the patient is an appropriate candidate for the surgery.

Patients who have a history of psychiatric or psychological disorder or are currently under the care of a psychologist/psychiatrist or are on psychotropic medications must undergo preoperative psychological evaluation and clearance and the patient’s record must include documentation of the evaluation and assessment.

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I went to the seminar and everything looks good so far. They said the 6mos supervised weight program will tansfer so I finish that up on Friday . They do it a little different there and said medicare should cover it no problem . I have to wait for them to approve everything though before the first visit. THey said it should only be about a month since I already finished everthing to qualify. I asked the surgeon about my medications and showed him the list and he said no major concerns that I could take them all the next day . Its only a 1day hospital stay that kinda seemed weird after reading on here ,he also said the surgury is reversable I had never heard that before . Im keeping my head up though and happy that they atleast act like its all gonna work out this go round . :D

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that's great news marcus :) I have medicare and was told they don't preapprove this surgery. Maybe medicare is different by state? I called them because I kept seeing ppl say they were approved prior so I was concerned. My clinic said they've never had probs getting things approved from medicare so I didn't worry. They do have an 1100 deductible which I didn't know about. Medicare required me to stay one night and I'm a lapband patient. Best of luck!

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thanks ill have to check on that deductible . hopefully its different in Tx.

Edited by marcus

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Ok medicare said yes there is a copay they only cover 80% but that since I had medicaid as a secondary it would cover the other 20% .

Edited by marcus

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Sorry to hear what you've been through with the process. Keep up the positive attitude and tenacity!

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I got a letter from the hospital yesterday saying I was approved by the insurance up to $50k .It said no money out of pocket too. I had to mail it back saying I stilll want the surgury to go further with it . I drove to the post offfice to get it in the mail the same day.Im so glad this is going much smoother than that try. :D

Edited by marcus

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Good news, Marcus.... happy for you

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the hardest part has been to stop smoking ive made it over a week now . thats the longest ever in 25 yrs . I really dont want them anymore now and what ever needs to be done to get this done im all for it . you all help me more than you know with the support. without this site I dont know where I would be at this point. ;)

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This all makes me want to give you a hug because that just has to be one of the most frustrating things ever! I do not suffer from a mental disorder but I had a similar situation. I started out with Barix in May 2010 and was told through them that all I needed was a psyche eval-- my insurance would then approve me because I meet the other standards, their insurance lady was a specialist and knew what she was doing, etc, etc. Thankfully, for whatever reason, they rubbed me the wrong way and I put off the psyche eval. because months into it..at the end of July, almost August when I am expecting to hear that I just need my psyche eval and then they can submit, I get a call stating that I can't even do their program nor have them perform my surgery. They aren't even authorized through my insurance! Supposedly, they had been talking with my insurance the entire time but then months later they aren't even covered with them? Not only that, but I come to find out I need a whole lot more than JUST a psyche eval! I had to have a 6 mo. monitored diet, 5 year weight history (I was missing 2 out of the 3 yrs so I used pictures), I needed an EGD bc of my acid reflux, etc, etc..so while I was thinking my time was the summer of 2010..I wasn't even looking to now have surgery until mid-2011! Just like you, I didn't give up and I encourage you to continue to fight for what you need and DESERVE. The drive may be crappy, having to start over may suck but you will gain your LIFE back and no one is allowed to take that away from you! I've been working on this for over a year now, I've had setbacks and letdowns along the way but now it is finally starting to come together and I can say it has been well, well worth it! I'll keep you in my thoughts, I hope things go smoothly and you see the approval from insurance that you need :)

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Thank you for the insite and support . I hope all goes smooth for you from this point.

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I got the call yesterday to set up the first visit at the nesw hospital. Its gonna be the 17th of next month . They said the psych was booked up till august . Looking forward to getting the ball rolling again .

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Good luck, Marcus! It should be smooth sailing from here on out! :)

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