Shot down

Last week on Tuesday I got a call that Dr Lalor's office was submitting to insurance for my DS. They expected the approval within a few days. I called yesterday. Still not back.  We talked about potential dates and she said if the approval came back yesterday she could potentially schedule me for 8/13.So today I called the insurance company and was told that the precert was never submitted. So....I called Dr Lalor's office back. I was told it would be resubmitted today and there must be an issue with their fax machine. 

Then... this is the kicker. .. she said she talked to Dr Lalor is not comfortable doing a DS on me because my BMI is under 50. Now almost 2 months ago I went in and met with him for this very reason and he said he would do it if he felt comfortable I understood the risk and to take a few weeks to think about it!!!!! Seriously????????

So... I didn't know what to say. She said he would still do the RNY. Well, I really don't want an RNY. So, I called the insurance company and was told that there was possibility I could go out of network if my PCP wrote a letter that the surgery was not available in this region.... but because its a weight loss surgery and there are other surgical options available it may not be approved. ( I still got the form!)

So...  I contacted my PCP and she knows nothing about the DS and seems uneasy about intervening since the DS is "the more risky procedure." So I need to go in and see her again..... 

I called Dr Kemmeters office. I should have listened and picked someone of the vetted list to begin with. Its 2.5 hrs away but I guess thats not terrible. The receptionist did not know what to tell me in regards to would I need to start the whole process over? What do I need to do with insurance vs what can they do? ETC and told me I had to talk to the pre-op patient coordinator. I called a couple of times and left a message for her but haven't heard back. Like I said I had everything done.... All my pre-op testing, my 3 months of physician supervised weight loss, my psych eval, etc.... If I have to start over from the beginning and I am going to cry. I'd be lying if I said I hadn't already teared up. I'm so disappointed!

I'm so freaked out and disgusted. Any tips of how to handle this?

Has anyone used Dr Kemmeter? Does he have the rule that you have to have a BMI over 50? 

If you can get all your records of your pre-op tests and supervised diet, you should be able to use them. I wish you luck with talking to your PCP. Perhaps some of Dr K's patients have some of his information or documentation you can share with your PCP.

--gina

 

The other two I am looking at would be Dr Schauer at Cleveland Clinic (not on the vetted list, but it seems like I am seeing his name more and more on the boards.) Also, Dr Maguire in Dayton, Ohio. They are both closer than Dr Kemmeter. I'm a little overwhelmed by the size of Cleveland Clinic though. 

I'm not as familiar with Mcguire and Schauer as I am with Kemmeter. Kemmeter is top notch, from all I've heard, and plenty travel to have him as their surgeon.

--g

Mine (Dr. Boyce) is not on the vetted list BUT...And he WILL let those under a 50 BMI get the DS. His partner (Dr. Williams) will not but he doesn't have anywhere near the experience that mine does. My pre-op BMI was 35.2. But I NEEDED NSAIDS and I wanted the best surgery for my diabetes.

Liz

The tests and diet were likely a requirement for your insurance, not the surgeon...right? If so, you will probably be able to use everything again as long as you get those records. A different surgeon might still require another test or two but you shouldn't have to redo any. My surgeon required a stress test even though the previous surgeon I was working with (and didn't go to) didn't require it.

Breathe! Don't get too worked up. There are other great surgeons out there. This is just one bump in the road. You'll move on to a new surgeon and be on your way soon.

Sonya, I can honestly tell you that you're not going to get any better than Kemmeter.    I was his twelfth DS seven years ago, and he just performed a hernia repair/abdominoplasty/panniculectomy on me a week ago.    He is cautious, highly skilled, kind and compassionate.    Nettie, his surgical coordinator, should be able to answer your questions, and I have a feeling you won't have to start over.   She just did some massive schedule juggling for to fit my surgery in to both my and his schedules, and went out of her way to help me out.   My starting BMI with him was a 46, and he has performed the DS on individuals with smaller BMI's than that for sure.     He IS going to expect that you have done your research on the DS, and that you absolutely understand the nutritional requirements and commitment that is involved in having one.   This is not a surgery to be handled in a non-chalant or negligent manner.   I have lost and successfully maintained 146 pounds, and I owe that man a debt of gratitude, and I let him know every time I see him!    I live about 1.75 hours from his office.   

Dr. Kemmeter is my surgeon and will be doing my DS Monday. He is great. The entire Grand Health Partners office is awesome. They have a store that sells vitamins and all the protein products on top of an amazing staff. Everything in the store can be ordered online by patients and shipped to your home so you wouldn't have to make the drive every time you needed something.

I'm not sure if he has a BMI rule but a quick call to their office and you would get your answer. Their number is 616-956-6100.

I doubt they will make you get the outside psych eval and all that again. They might run labs again, but they are also attached to a lab facility so you don't have to worry about adding more of a drive. They have a comprehensive team including behaviorists, dieticians, and exercise specialists.

I feel extremely lucky to only live 15mins from their office and work at the hospital where I will be having surgery.

Good luck on your surgery Monday!  What time is it?   I will be going down to GHP for my two week post-op check for my TT, and I'm not sure if I'm seeing Dr. K. or one of the PA's.   You are in gifted hands!

My surgery is at 12:30. I'll be arriving around 10.