DS Newbie Questions

[Spiky Bugger]

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

Yeah, but...I wait. Revenge is a dish best served cold, you know. So everyone must remain afraid...forever...

Slow burn

Slow burn.

Slow burn

Ut-oh


Oh, no.



Buh-bye, now.

 

[DianaCox]

My husband is in surgery, getting insurance-paid hernia repair AND an abdominoplasty. The coding for abdominoplasty is a cosmetic code that covers THREE procedures: diastasis recti repair, fatty tissue removal and skin fold (panniculus) removal. He only needed the diastasis repair, because closing the diastasis would make the umbilical hernia repair not require mesh, but there is no CPT code for JUST a medically necessary diastasis repair. Don't ask me why - the reconstructive plastic surgeon didn't know either. I had to coordinate the insurance submissions from the general and plastic surgeon, to make sure they went in together, including giving the general surgeon a "script" of words to use in her progress notes for the insurance submission that indicated that the PS's work was reconstructive when done in conjunction with her umbilical repair. I had to call the insurance company repeatedly to make sure the precert people UNDERSTOOD that there was no way to code the diastasis repair alone, and that in this case, the abdominoplasty was NOT cosmetic. They dawdled, but they approved it Friday night. He's in surgery right now.

AND - PS said, when he marked him up this morning, that since the abdominoplasty was approved, and it includes the skin excision, he's going to get a little FUPA lift along the incision line that had to be made anyway.

 

[newwomanin2015]

i really appreciate all of your help, and hope I am doing this right as it is the first time using a forum or threads or anything. So, am going to respond to everything in one spot, and hope that that is right rather than replying to each individually. Sorry, if that was not what I was supposed to do.

My concern about the hospital is if something goes wrong despite having a wonderful surgeon, like with that poor woman who had a major heart attack the day after her surgery, though, she said it was no fault of the doctor. She said she doesn't believe she would have survived had she not been in an actual hospital when the attack occurred. I read that the hospital chosen is as important as the surgeon. If something goes wrong, odds are much better at an actual hospital than a short term acute care center, which is what Forest Park is listed as. Even among hospitals, there are differences and have been looking like crazy for something Dr. Oz had written in one of his first books about what to call and ask nearby hospitals before you had an actual emergency.

Apparently, amongst hospitals there are ratings that have less to do with customer service, and more to do with what they are equipped to handle and there was a specific designation given to those that were equipped to handle a bigger variety of medical emergencies that would save valuable time versus having to be transported to another facility. Many even have certain types of equipment that not all hospitals have.

I am glad to hear they were certified as a center of excellence. When I looked Forest Park up on health grades website, it only gave them one star. However, I may have mixed them up with the one on 11990 N Central Expy, Dallas, TX, rather than checking on the one in Frisco, which sounds more on the ball.

You were right about checking the insurance and I have since done that. Usually, I am much better about that sort of thing, and neglected it briefly due to having a busy period at work. My insurance does not require a certificate of excellence, but, does require the 6 month diet stuff and psych evaluation. I have to check to see if insurance will allow my general practitioner to do the 6month consultation baloney!

Just want to make sure I do everything in my power to have the best outcome! After reading about the malpractice suit against Dr. Kim am very glad to steer clear of him!

It is so weird that it isn't easier to find lists somewhere that correspond to each other. Originally, was looking on the ASMBS site, and found list of 10 surgeons who performed the laproscopic DS. However, other sites either don't list these same surgeons, or, the surgeons do them, but, only in two stages. It seems as though this would be regulated somewhere where a good comprehensive list could be found. Had been told that ASMBS was essential, but, the surgeon seen the other day was not listed there, and folks have said she did their DS. The surgeon who owns the center is listed, but, not the surgeon who I would be getting.

Thank you all again for all of your help! I am learning so much, and am grateful!

ASMBS site lists for all of Texas:
Dr. Barker
Dr. Bonnor
Dr. Cantu Jr.
Dr. Ferrari
Dr.Gomez
Dr. Hamn
Dr. Leiva
Dr.Provost
Dr. Speigel
Dr. Wilson

 

[DianaCox]

IMNSHO:
Dr. Barker: Hell no
Dr. Bonnor: no - Bait-and-don't-switch
Dr. Cantu Jr.: never heard of him as a DS surgeon
Dr. Ferrari: never heard of him as a DS surgeon
Dr.Gomez: never heard of him as a DS surgeon
Dr. Hamn: never heard of him as a DS surgeon
Dr. Leiva: never heard of him as a DS surgeon
Dr.Provost: never heard of him as a DS surgeon
Dr. Speigel: Hell no
Dr. Wilson: meh

The surgeon you DO want in TX is Ayoola.

 

[JackieOnLine]

am going to respond to everything in one spot, and hope that that is right rather than replying to each individually.

your post was very clear and that's what matters.

welcome, by the way!

 

[Spiky Bugger]

I really appreciate all of your help, and hope I am doing this right as it is the first time using a forum or threads or anything. So, am going to respond to everything in one spot, and hope that that is right rather than replying to each individually. Sorry, if that was not what I was supposed to do.

I will go through and comment as I go.

My concern about the hospital is if something goes wrong despite having a wonderful surgeon, like with that poor woman who had a major heart attack the day after her surgery, though, she said it was no fault of the doctor. She said she doesn't believe she would have survived had she not been in an actual hospital when the attack occurred. I read that the hospital chosen is as important as the surgeon. If something goes wrong, odds are much better at an actual hospital than a short term acute care center, which is what Forest Park is listed as. Even among hospitals, there are differences and have been looking like crazy for something Dr. Oz had written in one of his first books about what to call and ask nearby hospitals before you had an actual emergency.

There are great hospitals with no DS surgeons and small hospitals where, because they are small, entire WINGS are filled with one surgeon's patients and everyone knows exactly what to look for. Before he moved, Keshishian did all of his surgeries in a little 100-bed hospital. I come from the land of Cedars-Sinai Beverly Hills and UCLA Medical Center. It was scary. But then, in my morphine induced haze, I realized that EVERY nurse, EVERY CNA, EVERY anybody there knew EXACTLY what my surgeon wanted. And exactly what he wanted to know about in terms of my condition.


Apparently, amongst hospitals there are ratings that have less to do with customer service, and more to do with what they are equipped to handle and there was a specific designation given to those that were equipped to handle a bigger variety of medical emergencies that would save valuable time versus having to be transported to another facility. Many even have certain types of equipment that not all hospitals have.

Yes, and Forest Park appears to be a surgery center, not a place for sick people. It is NOT listed as a Medicare hospital, so I could not read the reviews.

I am glad to hear they were certified as a center of excellence. When I looked Forest Park up on health grades website, it only gave them one star. However, I may have mixed them up with the one on 11990 N Central Expy, Dallas, TX, rather than checking on the one in Frisco, which sounds more on the ball.

Healthgrades is advertising. Ignore them, on everything. Maybe they are inspected and reviewed by some state agency and you could check ratings there?

You were right about checking the insurance and I have since done that. Usually, I am much better about that sort of thing, and neglected it briefly due to having a busy period at work. My insurance does not require a certificate of excellence, but, does require the 6 month diet stuff and psych evaluation. I have to check to see if insurance will allow my general practitioner to do the 6month consultation baloney!

Just want to make sure I do everything in my power to have the best outcome! After reading about the malpractice suit against Dr. Kim am very glad to steer clear of him!

Good doctors who are human can make mistakes. That's what malpractice insurance is about. But when a doctor has many lawsuits, or is found to have lied to try to hide his mistakes...different story.

It is so weird that it isn't easier to find lists somewhere that correspond to each other. Originally, was looking on the ASMBS site, and found list of 10 surgeons who performed the laproscopic DS. However, other sites either don't list these same surgeons, or, the surgeons do them, but, only in two stages. It seems as though this would be regulated somewhere where a good comprehensive list could be found. Had been told that ASMBS was essential, but, the surgeon seen the other day was not listed there, and folks have said she did their DS. The surgeon who owns the center is listed, but, not the surgeon who I would be getting.

Thank you all again for all of your help! I am learning so much, and am grateful!

ASMBS site lists for all of Texas:
Dr. Barker
Dr. Bonnor
Dr. Cantu Jr.
Dr. Ferrari
Dr.Gomez
Dr. Hamn
Dr. Leiva
Dr.Provost
Dr. Speigel
Dr. Wilson

Hell, there may not be that many DS PATIENTS in Texas...lol. If you are an ASBMS member and you tell them you do a certain surgery, they will list you there. See Diana's response to that list!

Sue

 

[Munchkin]

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.

*I* didn't have to do a psych eval. Maybe they already knew I was nuts?

 

[robs477]

My husband is in surgery, getting insurance-paid hernia repair AND an abdominoplasty. The coding for abdominoplasty is a cosmetic code that covers THREE procedures: diastasis recti repair, fatty tissue removal and skin fold (panniculus) removal. He only needed the diastasis repair, because closing the diastasis would make the umbilical hernia repair not require mesh, but there is no CPT code for JUST a medically necessary diastasis repair. Don't ask me why - the reconstructive plastic surgeon didn't know either. I had to coordinate the insurance submissions from the general and plastic surgeon, to make sure they went in together, including giving the general surgeon a "script" of words to use in her progress notes for the insurance submission that indicated that the PS's work was reconstructive when done in conjunction with her umbilical repair. I had to call the insurance company repeatedly to make sure the precert people UNDERSTOOD that there was no way to code the diastasis repair alone, and that in this case, the abdominoplasty was NOT cosmetic. They dawdled, but they approved it Friday night. He's in surgery right now.

AND - PS said, when he marked him up this morning, that since the abdominoplasty was approved, and it includes the skin excision, he's going to get a little PUFA lift along the incision line that had to be made anyway.

You are so dang good at that crap, you could be a consultant! Also, Best wishes for your Husbands speedy recovery.

 

[robs477]

I really appreciate all of your help, and hope I am doing this right as it is the first time using a forum or threads or anything. So, am going to respond to everything in one spot, and hope that that is right rather than replying to each individually. Sorry, if that was not what I was supposed to do.

I will go through and comment as I go.

ASMBS site lists for all of Texas:
Dr. Barker
Dr. Bonnor
Dr. Cantu Jr.
Dr. Ferrari
Dr.Gomez
Dr. Hamn
Dr. Leiva
Dr.Provost
Dr. Speigel
Dr. Wilson

Hell, there may not be that many DS PATIENTS in Texas...lol. If you are an ASBMS member and you tell them you do a certain surgery, they will list you there. See Diana's response to that list!

Sue

SOOO TRUE...the most pathetic part for me is....I've already been to 3 of those 10 on that "list" and going to my fourth and final one 3 hours from now.

 

[Larra]

Munchkin, your sanity was so obvious, so clear, so readily evident that no formal eval was needed.

Seriously, you are the first person who had bariatric surgery in the USA and wasn't self-pay that didn't need to do the psych eval.

 

[robs477]

*I* didn't have to do a psych eval. Maybe they already knew I was nuts?

Hmmmmm...guess that would be my # 3 biggest fear. 2nd being not able to get the DS, # 1 would of course be going in for the DS and waking up with the ole bait and no-switch sleeverooie! Dying under surgery would be either 4th or 5th, depending on whom you ask.

 

[DianaCox]

I perhaps COULD be a consultant, along with Larra, but very few could pay us what we're worth. And we would have to deal with very different attitudes from people who are paying us - we make the people we help do a good deal of the work, in order to make sure they have a good understanding of the DS and how to self-advocate in the future. Paying customers would balk. And it's also easier to fire a customer who isn't paying, if they become an asshole.

 

[Spiky Bugger]

You are so dang good at that crap, you could be a consultant! Also, Best wishes for your Husbands speedy recovery.

They people who need her help, to get insurance to pay, probably can't afford her any more than they can afford the surgery.

And besides...these big shot mouthpieces from fancy back-east schools are SUPPOSED TO do pro bono work...just so they are exposed to the downtrodden and the riff-raff. It makes them better people, dontcha know.

 

[Munchkin]

Munchkin, your sanity was so obvious, so clear, so readily evident that no formal eval was needed.

Seriously, you are the first person who had bariatric surgery in the USA and wasn't self-pay that didn't need to do the psych eval.

Odd huh? My insurance at the time was BCBS and they paid all but $100. Doc didn't require it either.

 

[Larra]

Amazing. I thought all the major insurers required a psych eval. I stand corrected.