Sunday, November 23, 2008

My Journey Part 1

For those of you who do not know, I have decided to take the steps necessary to get the LAP-BAND Procedure done. Before you ask, YES I have done my research, Ray is 110% with me on this, and we are aware of the life-style change this will be.
I had contacted a doctors office about 2 weeks ago, and set up some appiontments. Then I talked with a lady who I know that had it done, she had gone thru a company called True Results. She raved about the service she got from the people and the surgeon. She has been so happy with her band and everything, so I cantacted them. I made an appointment for 9:00am Friday Nov 21. I was very excited about this. So I had done my reasearch and knew what the insurance expected and covered.
I went in to the office and got taken right in. The first words out of this ladies mouth was....This procedure is excluded you have not coverage so we can talk financing....Needless to say I went through the ROOF. After I demanded she contact my insurance AGAIN, she told me what I already knew. Then asked me why I did tell the call center person it was Medically Necessary....DO I HAVE MD AFTER MY NAME? Anyways... So I started everything and got to the end. Did not care for the PA at all, but I am not a fan of them. After an hour 45 in the place where it was only suppose to be 1 hr, I left very unsatified and mad. After a phone call later in the day, and I checked my email it was all taken care of. This is what happended:
True Results is just a liason to go beteween the patient and doctor. They can not really answer any questions, it is for surgeons who do not do the 'One-Stop-Shop'. Also my insuracance requires the place doing the procedure is a (COE) 'Center of Expertise or Excellence' ...What is that. I could not find out. So this lady calls me back and tells me their center or their doctors are NOT covered by my insurance, but she did email me some information. I think she was really relieved knowing I would not be dealing with them.
So a COE is a **Hospital. **has been doing the procedure for 12 mo with low complication rate, **requires that after the 2 yr check up 90% of the patients have lost 50% of targeted weight. There are 6 locations in the aarea that are COE, and I think I have already found a doctor. I will contact them on Monday. Thankfully I do not have a waiting period so once all the other requirements are met, I will be able to go on with the procedure. I will keep you posted.

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