Looking for a Doctor to help.....

KLCouturier

New Member
:confused:
I was wondering if anyone in this forum could help me? I am trying to locate a Doctor in the Southern Maryland (preferably St. Marys County) area that has been of assistance or could possibly be of assistance in me going through with (spelling?)Liproscopic Gastro Intestinal Bipass Surgery (reduction of stomach for weight loss to correct severe obesity which is threatening ones life). I am looking for possibly a reference from someone that has dealt with a Doctor that has helped them plea the case to their health insurance provider that this procedure was medically necessary and either did the procedure themselves or referred you to a specialist in this region (even Baltimore or DC would be acceptable for the surgery, I am just looking for a local Doctor to help me get approved thru my insurance for this procedure to be done)

if you could please let me knoe if there is any of you that might be of assistance...my email is i_blong_2_hwkfxr@yahoo.com Thank you so very much!

Karen Couturier
 

DarbyOhara

Musician
Ummm.. you posted this twice....

However, I don't think any of us can help you out.. my best suggestion would be to call the 800 number in the yellow pages for that online nurse.... I think it exists down here... I know insurance companies can be hard to deal with... but may I ask.. which insurance company is it? Meaning, is it a HMO or a national carrier...
 

KLCouturier

New Member
Sorry, I didnt mean to post this twice.. I was trying to check if anyone had responded and accidentally somehow posted it again... I am new to this SOMD thing :)

I will try and look up what you suggested. I havent had a problem so far with my insurance provider, I just think it would be easier and much smoother going if I find a Doctor in this area that has delt with this sort of situation and surgery, not to mention finding a doctor that thinks this is a necessary measure instead of an easy way out is sometimes difficult. My husbands insurance is BCBS and it isnt an HMO, it is a PPO which is really actually quite good insurance so far. Thanks again for responding, and sorry for the double post! :)
 

DarbyOhara

Musician
Originally posted by KLCouturier
Sorry, I didnt mean to post this twice.. I was trying to check if anyone had responded and accidentally somehow posted it again... I am new to this SOMD thing :)

I will try and look up what you suggested. I havent had a problem so far with my insurance provider, I just think it would be easier and much smoother going if I find a Doctor in this area that has delt with this sort of situation and surgery, not to mention finding a doctor that thinks this is a necessary measure instead of an easy way out is sometimes difficult. My husbands insurance is BCBS and it isnt an HMO, it is a PPO which is really actually quite good insurance so far. Thanks again for responding, and sorry for the double post! :)

Hey, no problem... we all had to learn to get use to this... and welcome aboard! I am not familiar with that insurance, but the reason I asked is that HMO limits you to their coverage... I'd never do an HMO... One other suggestion would be to call the Shah center... don't know the # off hand.. but they seem to be the largest selection of specialists in this area. When you say you have to convince your insurance that it is necessary... have you already attempted to seek medical on this and they denied it? Or did you just inquiry on the telephone with them? I don't want to sound like I am asking too personal of questions.. but rather.. I am hoping by these questions some more alternatives may be available..... Regardless, good luck with your quest here... cause like I said, I know dealing with health insurance comapnies can be a pain in da butt!
 

KLCouturier

New Member
Nope, I agree, HMO sucks.. lol

I havent inquired with them as of yet about this procedure, but I am pretty confident they will want proof it is medically necessary and to be backed my a reputable Doctor that has dealt with this sort of thing would help my case. It just happens to be a surgery that I have done research on and know that insurance companies can be difficult to deal with trying to approve full coverage of this procedure. I have read a lot of articles and any info I cna find out on it and have narrowed it down to the specific type of procedure I want.. now finding any medical providers that do this in this area may be interesting.. lol
 

bknarw

Attire Monitor
I'd suggest heavy rods and heavy line with good backbone. A larger sized Penn reel could do the trick, and if you...oh...wait....I'm sorry. I thought you were looking for a good STURGEON!

My sincerest apologies.
 

watercolor

yeah yeah
who is your insurance Karen?????

Just asking...cause I know that I can go to the website of my insurance, and then I found doctors on there. I know that I am was not looking for that....but...it may help
 
I would suggest doing two things:

Go to http://www.bcbs.com/ and search for Gastroenterologists. I focused a search on Waldorf and got 100 doctors within a 20 mile radius. The only chance you will have in fighting the insurance company is if the doctor is in their network. BCBS is a big one, so that shouldn't be a problem.

Go to http://www.gastro.org/ and http://www.acg.gi.org/. See if you can get in contact with someone at those two organizations who might know of a doctor who has successfully gotten BCBS to pay for surgery.
 

KLCouturier

New Member
:)
Thank you SO very much for your help! I will look into that. I did call BCBS and they informed me my Docotr had to send in paperwork to them proving the surgery medically necassary, which I dont see a problem in that, but I do not want to lose valuable money on copayments to various doctors visits that will result in a doctor telling me they will not back me in the fight against my insurance company to pay for this because they do not agree it is medical neccessity. Thanks again for all your help!
 
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