Question:
What is my responsibility in securing coverage?

Tomorrow I have a consultation with Dr. Mikkleson at Agnasian Health in Fond du Lac WI. I am not sure if they take care of the footwork with my insurance carrier and/or what part I play. A year ago I began the surgery process in Neenah, but then found (after much waiting) that my insurance would not cover those docs. In that situation, I just was recommended to compile a letter to be sent with the paperwork the doctor's sent out. With this new doctor, there are no informational meetings...it is just this consult tomorrow. I do not know how to prepare myself for it. Anyone out there have an idea what I should do?    — Shawn S. (posted on April 19, 2004)

April 19, 2004
Hi Shawn, I'm your neighbor to the north - Oshkosh. I had surgery with the docs in Neenah in Feb 2003. I'd wait and see what they say tomorrow. My experience with most docs, including the ones in Neenah, is they do all the work as long as it falls into their "normal" process. Anything out of the ordinary and plan on doing it yourself. <p>My surgeon is an excellent surgeon but his office staff and I had a few go arounds before surgery as they were on their normal path of slow and methodical and I was on a fast track for approval and surgery. It all worked out but a few tempers flared here and there. If you already have a psych doc then call today and find out if he or she will need to see you to do a psych eval and if so get that appointment set up. Same for a sleep study. If they do not require these things you can always cancel the appointments. I was able to really speed up the process because I already had these types of docs in my arsenal and I took the bull by the horns and got the appointments scheduled, rather than wait and use the docs the program usually uses. I made it clear that was non-negotiable. I was using my regular docs. I wasn't about to have someone do a psych eval on me that knew nothing about me when I had a treating psychiatrist of over 3 years. My surgeon was fine with this. Write down your medical history and detailed diet history and take it along and ask them to submit it with their letter. A letter from you to insurance may be nice but probably not needed if the rest of the info is there and the doc does his or her job in their pre-authorization request. My surgeon left out the detailed diet history and consequently things got delayed because BCBS wanted it. I provided it directly to them. At the same time, I sent in info on the drugs I was on and likely to get off of. I wanted them to see the big picture. <p>Have you called insurance and know precisely what they require? If not, do that. Then you can relay that to the surgeon. Find out exactly where the request should be mailed and get a name if possible. My surgeon's office was submitting everything to Steven Point at that time and I knew that was wrong and would delay things, so I got a fax number and name in the FDL office, where all pre-auths are done. Do everything you can to help them do the job correctly. It's not like most docs offices don't get it straightened out eventually but I'm not a real patient person when things are taking much longer than they need to. <p>Feel free to e-mail me directly if you'd like. Maybe we could correspond and/or chat on the phone. My journey is pretty much coming to the end and now it's learning maintenance. I've already had a lower body lift and am scheduled for a 2nd procedure (upper portion of an abdominoplasty) on June 7th. After that it's arms, legs and breasts at some time in the future, after I hit the lottery. LOL It's been an amazing journey and one I could never have predicted would go so fast and turn out so well. 14-1/2 months later I am down 250 lbs and enjoying my smaller more agile body and turning into a clothesaholic. Good Luck!
   — zoedogcbr

April 19, 2004
Hi there, Shawn! My surgeon was in Milwaukee and although his office was more than willing to take care of all the paperwork, my doctor allowed me to do as much as I wanted. Turned out, I took charge of most of it and it made the process go through VERY FAST! I saw consult in late July and mid Sept. I had surgery. I made all me pre-op appointments and called and stayed on top of the insurance. ( I was approved in less than a week) I felt very empowered doing it myself. It is up to you whether you want to help out, some doctors don't mind, some may prefer that you let their staff do it all. I agree with Chris, see what happens after the consult. If you want, ask your surgeon how he/she feels if you help things along. Hope this helps. Vi open RNY 9/23/02 down 140 lbs.
   — Vi F.