Updated: Livid!! Am I just being irrational? Now APPROVED!

[-Flo-]

I would be so mad! I hope Dr. Simper works out.

 

[Pattycake813]

Youre reaction is totally reasonable. Get away from this surgeon..get one who cares about you.

If you could just lose 40lbs a month, you wouldn't be having weight loss surgery.. What a mega beotch. Almost 1 month post DS and I haven't even lost 40#. She is just trying to make it impossible for you. Find someone who will work with you, not against you. I put my surgery off almost a year because of a shitty surgeon, and looking back, I'm so glad I found a good one instead of proceeding with the other.

Good luck. We're all in your corner!

 

[Spiky Bugger]

I would be looking for another surgeon. That is utterly ridiculous. I'd beg, borrow or steal the $500 program fee and go with an experienced surgeon who doesn't do this bullshit.

It sounds to me like your current surgeon is deliberately trying to push you away. You wouldn't go after a man who treated you like this - why would you allow a doctor to treat you this way? FIND THE $500 AND GO TO SIMPER!!

What she said. Plus, since you say you have called almost daily...you have been identified as a pain in the ass and they don't want to deal with you post op.

 

[Spiky Bugger]

You embarrassed her big time in front of the proctor she had flown in when, prepped for surgery, the proctor probably saw the HRT on the chart and said no way. In her delusional mind, this was your fault. Also your fault is that she realizes she cannot get the proctor back in time for your insurance expiration causing further professional embarrassment. So she is blaming you and setting the impossible atonement of 40# in one month which she knows you cannot do. Instead of writing "I fucked up," she will write "non-compliant" in your chart, you will fade away and the problem is now solved.

So hell yeah. I'd be homicidal, not just livid.

Get another surgeon. She's dead to you.

Yup...what she said, too.

 

[k9ophile]

You can lose a shit load of weight in just one day: fire her ass. No pain, just gain.

 

[Amey]

I made a lot of phone calls today. I spoke to Christina at Dr Simper's office several times and my insurance company. And I got a direct extension to a supervisor at my insurance company. HOWEVER....nobody can tell me if changing providers will fuck my approval. I can't have two active numbers for the same procedure at the same time. So Dr Medvetz would have to void her approval before Dr Simper's paperwork could be processed. It basically starts all over with the pre-authorization. I don't know and nobody can tell me if my approval through the DOI will hold up with a different surgeon. When I have the current surgeon's authorization # voided then I'm flying blind... At the mercy of BC that denied me 5 times before the DOI overturned their denial. I know with a normal approval that providers can be changed because that's what I did when I had my lap band out. In fact Dr Simper had the original authorization and I had it moved to the current surgeon. But where this approval is based on the DOI I don't know and nobody can tell me if it is a whole authorization or for the surgery apart from the surgeon. However.... The same person in Medical Management at my insurance that denied my appeal to begin with said that it is all in the numbers... That Christina should send in the paperwork and make sure they have it before the other approval is voided.... That prevents a time-gap for the code. The coding has to be exact, the letters from DOI and BC's approval letter have to be sent and I have to write ANOTHER letter stating why I want to change providers. Christina at Dr Simper's said she won't be able to get a chance to look at my stuff for a couple of days.

And.... Out of the 5 DS surgeries the current surgeon has done....... I know that one had to be completely opened from between her boobs to her pubes because something was stuck to the bowel wall. Another girl only got a sleeve. And the 3rd one I know said she had a lot of complications and that Medvetz wouldn't own up to her mistakes or fix them so she had to go to another surgeon to be fixed. Hell no I don't want her touching me!!

Does anyone have any experience with changing surgeons after you are approved through a Dept of Insurance External Review? am I the only froot loop?

 

[DianaCox]

You're past my pay grade now. Honestly, you need to ask the DOI for an ombudsman to help walk you through the process.

 

[Charris]

I believe I read that Dr. K has a $3,500 out of pocket fee. Plus, travel expenses might make it a bit more expensive.

I hope you are able to get things to work out with Dr. Simper. Didn't you try his office earlier or, was that someone else? Be cool with his office people, nod and smile. You will get this!

He, Dr. K, had on in 2013 It was 4000 or 4500 for revision and I think 3000. But he had since gotten rid of the program fee. Last person I know who had surgery with him didn't have to pay it was told they no longer charge it

 

[Amey]

You're past my pay grade now. Honestly, you need to ask the DOI for an ombudsman to help walk you through the process.

I have an email in to Kate Frank at the DOI. She is going to look in to any restrictions on my appeal and get back to me in a couple days. I will definitely ask for an ombudsman. Thank you for the advice!

 

[Charris]

I made a lot of phone calls today. I spoke to Christina at Dr Simper's office several times and my insurance company. And I got a direct extension to a supervisor at my insurance company. HOWEVER....nobody can tell me if changing providers will fuck my approval. I can't have two active numbers for the same procedure at the same time. So Dr Medvetz would have to void her approval before Dr Simper's paperwork could be processed. It basically starts all over with the pre-authorization. I don't know and nobody can tell me if my approval through the DOI will hold up with a different surgeon. When I have the current surgeon's authorization # voided then I'm flying blind... At the mercy of BC that denied me 5 times before the DOI overturned their denial. I know with a normal approval that providers can be changed because that's what I did when I had my lap band out. In fact Dr Simper had the original authorization and I had it moved to the current surgeon. But where this approval is based on the DOI I don't know and nobody can tell me if it is a whole authorization or for the surgery apart from the surgeon. However.... The same person in Medical Management at my insurance that denied my appeal to begin with said that it is all in the numbers... That Christina should send in the paperwork and make sure they have it before the other approval is voided.... That prevents a time-gap for the code. The coding has to be exact, the letters from DOI and BC's approval letter have to be sent and I have to write ANOTHER letter stating why I want to change providers. Christina at Dr Simper's said she won't be able to get a chance to look at my stuff for a couple of days.

And.... Out of the 5 DS surgeries the current surgeon has done....... I know that one had to be completely opened from between her boobs to her pubes because something was stuck to the bowel wall. Another girl only got a sleeve. And the 3rd one I know said she had a lot of complications and that Medvetz wouldn't own up to her mistakes or fix them so she had to go to another surgeon to be fixed. Hell no I don't want her touching me!!

Does anyone have any experience with changing surgeons after you are approved through a Dept of Insurance External Review? am I the only froot loop?

I changed doctors, state the surgery would be in, and surgeries, from ERNY to sleeve to ERNY to ds and my approval was reaffirmed in 48 hours of Dr. K office submitting.

 

[Kristaz]

He, Dr. K, had on in 2013 It was 4000 or 4500 for revision and I think 3000. But he had since gotten rid of the program fee. Last person I know who had surgery with him didn't have to pay it was told they no longer charge it

I just used Dr. K 2 weeks ago. I have a $4k revision program fee. Payment due in full prior to surgery.

 

[Amey]

I changed doctors, state the surgery would be in, and surgeries, from ERNY to sleeve to ERNY to ds and my approval was reaffirmed in 48 hours of Dr. K office submitting.

Did you have to appeal to get approval or did your insurance just cover it?

 

[DSRIGGS]

He, Dr. K, had on in 2013 It was 4000 or 4500 for revision and I think 3000. But he had since gotten rid of the program fee. Last person I know who had surgery with him didn't have to pay it was told they no longer charge it

I had a revision and it was obviously due to a medical necessity to fix malnutrition, so although it was Bariatric surgery it wasn't like a virgin DS or "normal revision" for purposes of weight loss. A fee was never discussed nor charged.

 

[Charris]

Did you have to appeal to get approval or did your insurance just cover it?

My insurance just covered it. The dr I was using in AZ told insurance that it was insurance fraud because they felt they had done all the work to get approval then I took it elsewhere.

 

[Charris]

I just used Dr. K 2 weeks ago. I have a $4k revision program fee. Payment due in full prior to surgery.

Wow I know a rny To DS revision person and a new sleevers who had no program fee. Guess they were exception to the rule.