DS Newbie Questions

[newwomanin2015]

I am new to this, so, am trying to figure out how to ask questions. Anyway, went for first appointment Friday, and they had reviewed insurance and said it was 3 months following a diet plan, and no psych eval. Now, today, surgeon's office called and said that it is 6 months and an eval is needed, so am a little disappointed.

I am looking for surgeons that are experienced and good with doing DS, and doing it one stage, or, all at once. After leaving the office, discovered healthgrades,com, and surgeon did not get high marks. I have gone to several different websites and there doesn't seem to be a good, updated list of those who perform this procedure.

Some docs are on the asmbs listing as doing it while others are not, though, the docs claim they do it.

I am trying to find a surgeon who is good, and, of course, on insurance, within the Dallas, or Houston area as I live in Waco.

 

[southernlady]

@newwomanin2015

Going to the Dallas area is your best option... Dr. Ayoola in Dallas/Frisco/Plano the vetted DS surgeon there. http://www.weightlosssurgeon.com/

 

[robs477]

I am new to this, so, am trying to figure out how to ask questions. Anyway, went for first appointment Friday, and they had reviewed insurance and said it was 3 months following a diet plan, and no psych eval. Now, today, surgeon's office called and said that it is 6 months and an eval is needed, so am a little disappointed.

I am looking for surgeons that are experienced and good with doing DS, and doing it one stage, or, all at once. After leaving the office, discovered healthgrades,com, and surgeon did not get high marks. I have gone to several different websites and there doesn't seem to be a good, updated list of those who perform this procedure.

Some docs are on the asmbs listing as doing it while others are not, though, the docs claim they do it.

I am trying to find a surgeon who is good, and, of course, on insurance, within the Dallas, or Houston area as I live in Waco.

Hi and Welcome! Your timing couldn’t be better. There has been 2 or 3 recent post regarding this very subject. I am from Houston and another lady is also looking. Save yourself a world of time and go back through those threads. The unparalleled unanimous consensus amongst all these expert veterans is Dr. Ayoola in DFW area. If I lived in Waco, that’s where I would go without a doubt and may still end up going there anyways. Good luck to you!

 

[newwomanin2015]

Thanks so much for the response. I have seen a lot of the good info about him or her, and there is a Dr. Ayoola in my plan who might be the correct one. It doesn't say anything in the profile about bariatric surgery. My only concern is that it mentions Forest Park on the website, and would prefer a real hospital in case something goes wrong. Thanks for the welcome!

 

[Elizabeth N.]

Howdy, glad you found the forums! I'll bet the Ayoola in your plan is the one folks here are talking about. How many times would that name be found among surgeons and in the same area?

 

[robs477]

Howdy, glad you found the forums! I'll bet the Ayoola in your plan is the one folks here are talking about. How many times would that name be found among surgeons and in the same area?

Im 99.99% sure this is the same Dr. The Forest Park Medical Center and it is a certified Bariatric Surgery Center of Excellence and list Dr. Ayoola, so that’s pretty for sure. I really had to look for that info. Usually that certification is displayed on the front page of the website, but I actually had to google it a different way to find it. They should really put that on the site?? I just looked all that up myself because my insurance requires that the surgery be done in a Hospital that has that certification also. It sounds like this Lady and I may have the same plan. Looks like pretty good news for her!!!

http://fpsurgicalcare.com/bariatrics/

 

[southernlady]

My only concern is that it mentions Forest Park on the website, and would prefer a real hospital in case something goes wrong. Thanks for the welcome!

Many of our members who have used Dr. Stewart (may he RIP) and now Dr. Ayoola have used Forest Park and none have mentioned it not being a "real" hospital. I know it says "medical center" not hospital but it's still a real hospital.

Im 99.99% sure this is the same Dr. The Forest Park Medical Center and it is a certified Bariatric Surgery Center of Excellence and list Dr. Ayoola, so that’s pretty for sure. I really had to look for that info. Usually that certification is displayed on the front page of the website, but I actually had to google it a different way to find it. They should really put that on the site?? I just looked all that up myself because my insurance requires that the surgery be done in a Hospital that has that certification also. It sounds like this Lady and I may have the same plan. Looks like pretty good news for her!!!

http://fpsurgicalcare.com/bariatrics/

I know MANY insurance companies insist on the facility be a COE (mine did) but that really ONLY means you get it paid for. Even the CMS.gov (Centers for Medical Services, the people who handle and implement Medicare and Medicaid NO LONGER require the facility be a COE.

What is a COE:

The term “Center of Excellence” first came into general use in 1991 when the Centers for Medicare & Medicaid Services (CMS) started its Medicare Participating Heart Bypass Center Demonstration project. Initially, designation as a “Center of Excellence” had nothing to do with providing excellent health care; instead it described hospitals participating in the project, which had lowering health care costs as a primary goal.

A hospital was deemed a “Center of Excellence” if it teamed up with CMS (then known as the Health Care Financing Administration, or HCFA) to negotiate a package price for an episode of care. That package price combined physician and hospital fees into a single payment to the hospital. The hospital then distributed shares of the payment to all the providers involved in the provision of care (including the hospital itself). This was seen as a way of “aligning the interests” of physicians and health care institutions.

From the beginning, physicians had concerns about the designation. When a proposal to expand the demonstration project to total joint replacement was developed in 1996, the AAOS issued a position statement opposing the designation of hospitals as “Participating Centers of Excellence” and the use of the term as a marketing device.

Bolding is mine.

 

[robs477]

Many of our members who have used Dr. Stewart (may he RIP) and now Dr. Ayoola have used Forest Park and none have mentioned it not being a "real" hospital. I know it says "medical center" not hospital but it's still a real hospital.


I know MANY insurance companies insist on the facility be a COE (mine did) but that really ONLY means you get it paid for. Even the CMS.gov (Centers for Medical Services, the people who handle and implement Medicare and Medicaid NO LONGER require the facility be a COE.

What is a COE:



Bolding is mine.

I did not know that. That just figures huh? You guys know everything..lol!!!!

 

[Larra]

Review your insurance yourself. No one cares more about this more than you, right? I've seen too many stories where people were told, just for one example, that their monthly diet check-ins were ok with a nutritionist, they do this for 3 or 6 months and THEN learn that their insurance will only accept visits with the doctor. And someone already screwed up big time, because there is no insurance that I know of in the USA that doesn't require a psych eval, it's considered so basic and so essential. Now, if someone is self-pay in another country, that's a different story, but to get insurance coverage everyone gets a psych eval.
So don't trust others to get all the details right for you, review your coverage yourself.

And yes, Dr. Ayoola, definitely a great choice.

 

[Spiky Bugger]

Im 99.99% sure this is the same Dr. The Forest Park Medical Center and it is a certified Bariatric Surgery Center of Excellence and list Dr. Ayoola, so that’s pretty for sure. I really had to look for that info. Usually that certification is displayed on the front page of the website, but I actually had to google it a different way to find it. They should really put that on the site?? I just looked all that up myself because my insurance requires that the surgery be done in a Hospital that has that certification also. It sounds like this Lady and I may have the same plan. Looks like pretty good news for her!!!

http://fpsurgicalcare.com/bariatrics/

You can argue your way around that COE thing. I did. And I prevailed.


ETA...once they figured out that they would have to pay transportation and hotel etc for me and my caregiver to get to and camp near a COE where a DS surgeon practiced. And at the time, there was not one in CA, so it would have meant SERIOUS out of state travel and paying doctors not in their network. They alway opt for cheap.

 

[Larra]

I think Spiky can argue her way around anything.

 

[Spiky Bugger]

She certainly tries...lol


In my defense, however....BC approved a DS, but then insisted that I use a COE. There were no DS doctors using COE facilities at that time. I told them that it was like their saying that I could have a hamburger or a chicken sandwich or a filet mignon...only I had to get it at Burger King. By making me use Burger King, they were effectively denying me the filet mignon, which was a violation of our agreement...unless they wanted to pay for me and my husband to go out of state to a COE hospital, but of course those surgeons wouldn't be part of BC and ight cost them a bit more. So there...lol

And I did not discuss this with customer service...I discussed it with their legal department.

 

[southernlady]

She certainly tries...lol


In my defense, however....BC approved a DS, but then insisted that I use a COE. There were no DS doctors using COE facilities at that time. I told them that it was like their saying that I could have a hamburger or a chicken sandwich or a filet mignon...only I had to get it at Burger King. By making me use Burger King, they were effectively denying me the filet mignon, which was a violation of our agreement...unless they wanted to pay for me and my husband to go out of state to a COE hospital, but of course those surgeons wouldn't be part of BC and ight cost them a bit more. So there...lol

And I did not discuss this with customer service...I discussed it with their legal department.

I'll have to remember that one!

 

[chevtow]

mmmmmmm filet mignon

 

[robs477]

I think Spiky can argue her way around anything.

Including a Fence post...and probably win too!...lol I might be new on this site...but, I'm a relatively fast learner!