Turned in insurance info to Dr. Keshishian...

[Melanie0574]

Well I had my appt.,and they were really pushing the sleeve. The doctor did'nt even ask which procedure I was interested in,and by the end of the appt. I felt like they were going to come in,and whisk me away to the hospital,and start the surgery. lol They set up an appt for me to have a upper gi endoscopy,and gave me a nutritionist,and a psychiatrist to call to make appointments with. I left there feeling like things were moving way to fast,and knowing that I really don't want the vertical sleeve. So I think on Monday I will call,and tell them that I appreciate the time that they took,but that I really would like a referral to a surgeon that does the DS, either Rabkin or Keshishian. Has anyone else gone to a consult,and felt like they were just going to open you up right there? lol

 

[southernlady]

Well I had my appt.,and they were really pushing the sleeve. The doctor did'nt even ask which procedure I was interested in,and by the end of the appt. I felt like they were going to come in,and whisk me away to the hospital,and start the surgery. lol They set up an appt for me to have a upper gi endoscopy,and gave me a nutritionist,and a psychiatrist to call to make appointments with. I left there feeling like things were moving way to fast,and knowing that I really don't want the vertical sleeve. So I think on Monday I will call,and tell them that I appreciate the time that they took,but that I really would like a referral to a surgeon that does the DS, either Rabkin or Keshishian. Has anyone else gone to a consult,and felt like they were just going to open you up right there? lol

I would have stopped and said..."while the sleeve is part of what I want, I want the malabsorptive part as well, since I know the sleeve alone is not enough for me. Do you do the DS?"

 

[Larra]

I would not have them (or their GI person) do the endoscopy if you are going to Dr. K, because last I recall he does his own, but of course his office staff could confirm that for you.
I would also not go forward with the other appts. The only purpose of this consult was to see an in-network bariatric surgeon, request the DS, get told he doesn't do it, so that you can now turn to your insurance and demand a consult with the out of network surgeon. That's it. The longer you proceed with this surgeon and his program, the more time you waste (not to mention appts that will just end up being repeated).
If you didn't confirm that he doesn't do the DS, do that on Monday by calling his office, then call the insurer. And since you may be in for a fight, it's time to start documenting everything - keep all correspondence, all emails, make a note of every phone call with date, time, name and job title of the person you speak with, their phone number, and a summary of the conversation. If the random insurance company employee you get on the phone can't or won't help you, request to speak with a supervisor, and document any refusals, etc. You will need to be very organized and persistent.

 

[Melanie0574]

I would not have them (or their GI person) do the endoscopy if you are going to Dr. K, because last I recall he does his own, but of course his office staff could confirm that for you.
I would also not go forward with the other appts. The only purpose of this consult was to see an in-network bariatric surgeon, request the DS, get told he doesn't do it, so that you can now turn to your insurance and demand a consult with the out of network surgeon. That's it. The longer you proceed with this surgeon and his program, the more time you waste (not to mention appts that will just end up being repeated).
If you didn't confirm that he doesn't do the DS, do that on Monday by calling his office, then call the insurer. And since you may be in for a fight, it's time to start documenting everything - keep all correspondence, all emails, make a note of every phone call with date, time, name and job title of the person you speak with, their phone number, and a summary of the conversation. If the random insurance company employee you get on the phone can't or won't help you, request to speak with a supervisor, and document any refusals, etc. You will need to be very organized and persistent.

I thought I was supposed to request a referral from the in-network surgeon for a consult with a out of network surgeon,not request it from my insurance. I was told at my appt that he doesn't do the DS,and I have no plans on going forward with the other appts,since there would be no point in doing so. So tomorrow I will call,and cancel the GI appointment,and then call my insurance to request a consult for Dr. K

I really appreciate everyone's help with this.

 

[southernlady]

When I decided I wanted the DS, I needed to find a surgeon willing to handle a lightweight. Boyce's partner was my original surgeon and he won't do someone lower than a 50 BMI. So I went elsewhere. Naturally that lead me out of state. I was with BCBS TN Medicare so finding a surgeon who accpted Medicare (and BCBS) was important. I found one...the one my husband (different insurance) was able to use.

BCBS TN Medicare approved my DS BUT NOT MY choice of surgeons. They said I had to look in state unless there was not one in state. So I made an excel spreadsheet of ALL the bariatric surgeons in TN. I started with the known DS surgeons (Nashville had 3 at the time, Knoxville had 2 (mine and the partner I fired). The Nashville surgeons, 2 did not accept a Medicare policy (even an advantage plan) and the third did not handle LW's.

I called every blasted surgeon on my list...had all no's to a DS or not in network or not willing to do the DS on a LW. I FINALLY called Boyce's office and Williams had to agree to let me switch surgeons for Boyce to say yes. Had I gotten a no from Williams, I would have had exactly what my appeal needed for my policy. But Boyce agreed. I didn't need an in network referral to an out of network for ME but I had to do the "leg work" to prove it needed to be done out of state.

 

[Larra]

@Melanie0574 you can get @DianaCox opinion as well, but I haven't heard of an in-network surgeon doing a referral to an out of network surgeon, I believe it's up to you to deal with your insurer at this point. Your desire for a procedure he doesn't perform is not his problem. But Diana gets the final word.

 

[DianaCox]

I think it depends on your insurance. With my daughter's first insurance, her reproductive endocrinologist knew her case was beyond her capabilities, so the RE tried to refer her to DrN, who is out of network - but that didn't work - my daughter's PCP, who knew NOTHING about what was going on, had to request the referral; the plan she has now, she needs another referral to DrN - this time, the RE was able to make the referral.

The main thing is, you needed to tell the in-network bariatric surgeon that you want the DS, and get it in writing that he doesn't do it. You can ask him for a referral to Dr.K, and then if he refuses, you can appeal that denial. OR you might have to go back to your PCP and ask for the referral - depends who's your gatekeeper. But you need a DENIAL to appeal to the insurance company.