Hello from Oklahoma

[august6star]

Hi, I am hoping to have one of the weight loss options soon. I have went through everything (Ecko, Mental Health interview, 3 months of dietitian appointments) and have just been waiting on an approval letter from my insurance. Well, actually, I got a denial and am so confused right now. It looks like HealthChoice of Oklahoma has upped the BMI for a Modified DS to 60. I am only a 40.5 so I do not qualify now. I feel so defeated and have already put a lot on my Care Credit card to get this process started.

 

[southernlady]

Welcome august6star
I’m gonna tag our two insurance gurus on this.
You will need a copy of your Evidence of Coverage. You probably will get it from the HR dept where you work. And it’s a good size document.

DianaCox Larra

 

[DianaCox]

Please provide a copy of the insurance company’s bariatric policy as well.

 

[hilary1617]

Hi and welcome august6star. Hope you can get coverage.

 

[JackieOnLine]

Hi & Welcome august6star

I feel so defeated

not surprising, but don't give up.

 

[august6star]

Please provide a copy of the insurance company’s bariatric policy as well.

Hi Diana, would the policy be on my HealthChoiceConnect portal?

 

[august6star]

It don’t go into much detail.

 

[Spiky Bugger]

No. That’s a VERY BRIEF summary. The document is CALLED “Evidence of Coverage.” It is MANY pages long.


One thing I did notice…and that will likely be covered in the document you need, is that they want you to go to one of “their” centers. I had to deal with that issue. I wanted…NEEDED…the DS, duodenal switch. And I wanted the surgeon I wanted. I ended up sending an email to every one of the centers MY insurance listed as “in network,” even though I knew what surgeon I wanted and that he was not in network. Then, since every one said they did not have a surgeon who performed the DS at their facility, I had the ammunition I needed to require them to pay for the DS with the surgeon I wanted.

BUT, work with Diana and Larra. They are the insurance pros!

PS—don’t panic and agree to whatever surgery, at whatever facility, by whatever doctor because you “have to do something!” Take the time to get what YOU want and need.

 

[southernlady]

august6star are you the person who went to the Roller Clinic and was told they would do the RNY or VSG?

If so, is the Roller Clinic the only clinic you are allowed? If so, there are many strikes against it. Roller has allowed a surgeon (Dr. Kwon) to remain on staff that has butchered a person. He also has committed fraud with insurance companies billing for a DS and doing a SADI.

Hopefully you can travel because to get a DS, you are gonna need to, most likely.

 

[august6star]

Yes, that is me. I have talked to Cindy and was going to use Dutton. My question though is “if they can’t do the traditional (I know it’s not the real traditional) surgery do to insurance, can another surgeon get me approved? A place called Weight Wise in Oklahoma told me that they liked the patients BMI to be 50 or higher for a Traditional Doudenal but if I was adamant they would do it. Am I wasting my time trying another surgeon?

 

[august6star]

No. That’s a VERY BRIEF summary. The document is CALLED “Evidence of Coverage.” It is MANY pages long.


One thing I did notice…and that will likely be covered in the document you need, is that they want you to go to one of “their” centers. I had to deal with that issue. I wanted…NEEDED…the DS, duodenal switch. And I wanted the surgeon I wanted. I ended up sending an email to every one of the centers MY insurance listed as “in network,” even though I knew what surgeon I wanted and that he was not in network. Then, since every one said they did not have a surgeon who performed the DS at their facility, I had the ammunition I needed to require them to pay for the DS with the surgeon I wanted.

BUT, work with Diana and Larra. They are the insurance pros!

PS—don’t panic and agree to whatever surgery, at whatever facility, by whatever doctor because you “have to do something!” Take the time to get what YOU want and need.

That is just the advice I needed right now, thank you. One moment I want to wait and do what is best and wait for a surgeon who might do it, then I think about going with the gastric bypass just to get it over with this year since my deductible has almost been met. I have already told close friends and family and planned it for Christmas break. I do agree I need to wait, I just hope there is a light at the end of this tunnel.

 

[southernlady]

Yes, that is me. I have talked to Cindy and was going to use Dutton. My question though is “if they can’t do the traditional (I know it’s not the real traditional) surgery do to insurance, can another surgeon get me approved? A place called Weight Wise in Oklahoma told me that they liked the patients BMI to be 50 or higher for a Traditional Doudenal but if I was adamant they would do it. Am I wasting my time trying another surgeon?

No, you aren’t wasting your time. I had to call every bariatric practice in the state of Tennessee to get mine.

 

[Georgepds]

Re "One moment I want to wait and do what is best and wait for a surgeon who might do it, then I think about going with the gastric bypass just to get it over with this year since my deductible has almost been met"

Unless you are very close to the edge financially, I'd go with the DS. it's a much more effective surgery than the RNY, and you will be living with the result for years.

Over the years, the deductible will just dissappear as an issue.

 

[Larra]

Very well put Georgepds !

 

[august6star]

No, you aren’t wasting your time. I had to call every bariatric practice in the state of Tennessee to get mine.

Well, I guess it’s a good thing I’m on Thanksgiving break next week. I will try calling the ones that my insurance covers. I have noticed that several want you to pay a fee of about $100 up front at the initial visit. Then it’s so hard to get a straight answer. Like at Roller. Roller was insurance appt and they told me through the whole darn process that it was approved. I asked every single time because I had my doubts, then at the last minute, I am denied. I hope I have better luck thanks for all of your encouraging words!