jim1969
Well-Known Member
- Joined
- Mar 23, 2014
- Messages
- 313
Here is the whole story about my Dr.
So before I go into what happened yesterday I have to tell you about prior to this meeting. I have state insurance and needed to go to a bariatric Center of Excellents to be covered. After looking in my state of WI nobody really does the DS but there was one Dr Thomas Chua that had it listed on his web site. So after calling they had me go to the seminar knowing I was interested in the DS. I went to their seminar and he went through the different surgeries even the DS. After the seminar I hung around talking to him about the DS and the insurance I had and it didn't seem like there was a problem with the whole thing so I made an appointment to visit the coordinator and nutritionist. Everything was going great until I mentioned my surgery of choice the DS The nutritionist said that I don't think he does that surgery so she excused her self and went to talk to the coordinator they came back in and asked if I had talked to the Dr about this choice and I said yes and that he doesn't do a lot of them but he said he could do the surgery if that's what I wanted. They told me that maybe it would be a good idea to meet him before we go through all of the program and find out he doesn't do it. I went to see him and told him I was only interested in the DS but he went through all the surgeries with me again and it seemed he was wanting me to have the RNY. Needles to say I told him that I was here to find out if he did do the DS and how many he had done in the past. He said he does do them but has done only around a dozen. So we talked about the DS some more and his experience in Bariatric surgery and I left feeling good about the whole experience with him and his staff. I then started and finished all my requirements for the insurance company and the bariatric program which leads me to yesterday.
I got to the office and was an hour late which was my fault I looked at the wrong date on the calendar and a different appointment that was for my PCP. So the lady at the desk turns to the other lady and says my 10 o'clock appointment is here they talked a little bit and she returned saying that the DR has an opening on Monday at 10 O'clock again. I said really I just drove 4hrs to get here and I thought I was actually early for my appointment and now your telling me that Im late and I will have to come back is there any way he can get me in yet today? She asked who had sent me to the clinic and I told her that I had finished the program and was here to discuss the surgery and then they could send the info to the insurance for approval. She then handed me a bunch of paperwork and said I needed to fill it out and that it would take me some time to do it. I started filling out the paperwork and it was all the same stuff I had already filled out during the first visit so I asked her if this was the same as I filled out last time and she had this puzzled look on her face and went and pulled my file she turned as said yup you already have it done.
Ok so Im not feeling very comfortable at this time 1 shouldn't they have known why I was there and who sent me? 2nd shouldn't they have pulled my records before they gave me all this paper work? 3rd they didn't seem as nice as my first meeting but it may be because I was late. So anyway I got in to see the Dr and he starts asking me who sent me here and why was I there. After retelling my story again he goes through all the same questions he had asked me on my first visit and starts going through all the surgeries with me again but he leaves out the DS. Then he asks me what surgery I was interested in and I told him the DS and he starts to tell me all the bad things that could happen during surgery with the DS so I interrupted him politely and said any of that stuff could happen with any surgery he agreed and started telling me about all the trouble I could have with the DS. It was apparent he was trying to get out of doing the DS as he grabbed his board with all the different surgeries he flips it open to the RNY and starts to explain why this is a better option. I interrupted his speech and told him I was only interested in t he DS and that I had done enough research about all the other surgeries and was not willing to have any other surgery. He then tells me that my insurance will not cover the DS or even a sleeve my choices would be a band or RNY but If I wanted he would summit it to the insurance company anyway. WTF I just went through all this stuff and now he tells me this? Why not tell me at the beginning? I know some of you are going to say well He is not a surgeon on here and you should have chosen one of them but the reality is that when I talked to the insurance company they told me they cover all bariatric surgeries if medically necessary and that it had to be instate. Anyway I left feeling sick about the whole thing. So now what to do?
When I got home I called the insurance company again and asked if the University of Chicago was in my network and they said no unless I got pre authorization for the hospital and surgeon but they may deny it and make me go instate. I also called the University of Chicago and talked with their bariatric coordinator for DR Prachand and they are willing to try to get the preauthorization and work with me. They also said they would not make me go through all of the nutrition classes again.
I guess Im not totally positive he gave me the bait and switch but it sure seemed that way. I am going to let him submit it to the insurance and see what happens. He has said he has done some DS surgeries in the past so I don't want to turn anyone off at this point. I will keep you posted.
So before I go into what happened yesterday I have to tell you about prior to this meeting. I have state insurance and needed to go to a bariatric Center of Excellents to be covered. After looking in my state of WI nobody really does the DS but there was one Dr Thomas Chua that had it listed on his web site. So after calling they had me go to the seminar knowing I was interested in the DS. I went to their seminar and he went through the different surgeries even the DS. After the seminar I hung around talking to him about the DS and the insurance I had and it didn't seem like there was a problem with the whole thing so I made an appointment to visit the coordinator and nutritionist. Everything was going great until I mentioned my surgery of choice the DS The nutritionist said that I don't think he does that surgery so she excused her self and went to talk to the coordinator they came back in and asked if I had talked to the Dr about this choice and I said yes and that he doesn't do a lot of them but he said he could do the surgery if that's what I wanted. They told me that maybe it would be a good idea to meet him before we go through all of the program and find out he doesn't do it. I went to see him and told him I was only interested in the DS but he went through all the surgeries with me again and it seemed he was wanting me to have the RNY. Needles to say I told him that I was here to find out if he did do the DS and how many he had done in the past. He said he does do them but has done only around a dozen. So we talked about the DS some more and his experience in Bariatric surgery and I left feeling good about the whole experience with him and his staff. I then started and finished all my requirements for the insurance company and the bariatric program which leads me to yesterday.
I got to the office and was an hour late which was my fault I looked at the wrong date on the calendar and a different appointment that was for my PCP. So the lady at the desk turns to the other lady and says my 10 o'clock appointment is here they talked a little bit and she returned saying that the DR has an opening on Monday at 10 O'clock again. I said really I just drove 4hrs to get here and I thought I was actually early for my appointment and now your telling me that Im late and I will have to come back is there any way he can get me in yet today? She asked who had sent me to the clinic and I told her that I had finished the program and was here to discuss the surgery and then they could send the info to the insurance for approval. She then handed me a bunch of paperwork and said I needed to fill it out and that it would take me some time to do it. I started filling out the paperwork and it was all the same stuff I had already filled out during the first visit so I asked her if this was the same as I filled out last time and she had this puzzled look on her face and went and pulled my file she turned as said yup you already have it done.
Ok so Im not feeling very comfortable at this time 1 shouldn't they have known why I was there and who sent me? 2nd shouldn't they have pulled my records before they gave me all this paper work? 3rd they didn't seem as nice as my first meeting but it may be because I was late. So anyway I got in to see the Dr and he starts asking me who sent me here and why was I there. After retelling my story again he goes through all the same questions he had asked me on my first visit and starts going through all the surgeries with me again but he leaves out the DS. Then he asks me what surgery I was interested in and I told him the DS and he starts to tell me all the bad things that could happen during surgery with the DS so I interrupted him politely and said any of that stuff could happen with any surgery he agreed and started telling me about all the trouble I could have with the DS. It was apparent he was trying to get out of doing the DS as he grabbed his board with all the different surgeries he flips it open to the RNY and starts to explain why this is a better option. I interrupted his speech and told him I was only interested in t he DS and that I had done enough research about all the other surgeries and was not willing to have any other surgery. He then tells me that my insurance will not cover the DS or even a sleeve my choices would be a band or RNY but If I wanted he would summit it to the insurance company anyway. WTF I just went through all this stuff and now he tells me this? Why not tell me at the beginning? I know some of you are going to say well He is not a surgeon on here and you should have chosen one of them but the reality is that when I talked to the insurance company they told me they cover all bariatric surgeries if medically necessary and that it had to be instate. Anyway I left feeling sick about the whole thing. So now what to do?
When I got home I called the insurance company again and asked if the University of Chicago was in my network and they said no unless I got pre authorization for the hospital and surgeon but they may deny it and make me go instate. I also called the University of Chicago and talked with their bariatric coordinator for DR Prachand and they are willing to try to get the preauthorization and work with me. They also said they would not make me go through all of the nutrition classes again.
I guess Im not totally positive he gave me the bait and switch but it sure seemed that way. I am going to let him submit it to the insurance and see what happens. He has said he has done some DS surgeries in the past so I don't want to turn anyone off at this point. I will keep you posted.
