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  1. #1
    Gastric Sleeve Member Awesomassager's Avatar
    I have had a gastric sleeve.
    Name
    Amanda
    Surgery date
    11/02/2011
    Surgeon
    Dwayne Smith
    Join Date
    Oct 2011
    Last Activity
    10-26-2018 09:39 PM
    Location
    KY
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    43
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    Default UGH.... My does my surgeons staff lie???


    I was approved by my insurance last Thursday, but the staff refuses to make an appointment. I had my last class today with the NP asking whatever questions I still had. Before this appointment I get there early to talk to them about making my appointment for the first week of November. They tell me they cant make the appointment because the NPI numbers are changing, since the surgeon was bought out of his practice and is now with the Hospital. I told the NP this and she said that isnt right. They got the new NPI numbers in August. Funny, that this is the second time the staff has lied to me. The NP told me to call her Wednesday, she said she will work on my case tomorrow to find out what the hold up is. She was the one who helped me get my paperwork sent into the insurance ASAP. She is my angel!! I also go the letter approving the Sleeve today , but it was only for one day.. Does this seem right? Dont they have to precert the whole stay (3-5 days)?



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  3. #2
    Gastric Sleeve Member Lglow's Avatar
    I have had a gastric sleeve.
    Surgery date
    09/19/2011
    Surgeon
    Dr.Parker
    Join Date
    Jun 2011
    Last Activity
    05-09-2012 08:01 AM
    Posts
    452
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    Blog Entries
    7

    Default Re: UGH.... My does my surgeons staff lie???

    Wow, its a good thing you have a good nurse advocating for you. She will get it straightened out. So sad your going through this. It will come. She will advocate for you and get it straightened out! It sounds like the doctors office is really jacking you around. Hang in there. Keep us posted!!!!



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  5. #3
    Gastric Sleeve Member Sunflower's Avatar
    I have had a gastric sleeve.
    Surgery date
    03/10/2012
    Surgeon
    Dr Ramos Kelly
    Join Date
    Sep 2011
    Last Activity
    09-08-2013 09:47 PM
    Location
    California
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    3,477
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    Default Re: UGH.... My does my surgeons staff lie???

    What is an "NPI" number? You may have a capitation plan, which most of us with HMOs have. The doctor gets paid just as much by the insurance company if he does 10 procedures or 50, (arbitrary numbers on my part. I don't know what numbers are exactly) so of course he is only motivated to do as many as he has to in order to get paid: capitation. Your doc may already have enough bookings for next month with people who have your plan to make his billing requirement.

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  7. #4
    Gastric Sleeve Member Rae's Avatar
    I have had a gastric sleeve.
    Name
    Rae
    Surgery date
    09/28/2011
    Surgeon
    Hoehn
    Join Date
    Aug 2011
    Location
    midwest USA
    Posts
    899
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    Default Re: UGH.... My does my surgeons staff lie???

    Mine was only an overnight stay and I know someone that did it as an outpatient. Maybe you will only be in one night.





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  9. #5
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Surgery date
    10/14/2011
    Surgeon
    Enoch
    Join Date
    Sep 2011
    Last Activity
    08-06-2014 08:49 PM
    Posts
    55
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    Default Re: UGH.... My does my surgeons staff lie???

    I think one night is standard, two nights is bonus. Probably not gonna get 3-5 unless major complications...


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  12. #6
    Gastric Sleeve Member kimfj2's Avatar
    I have had a gastric sleeve.
    Name
    Kim
    Surgery date
    08/15/2011
    Surgeon
    Dr. Turton
    Join Date
    Mar 2011
    Last Activity
    03-07-2013 07:05 AM
    Location
    Alabama
    Posts
    124
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    Default Re: UGH.... My does my surgeons staff lie???

    My insurance approved two nights, but I only stayed one night. With them, BCBS, one night is considered outpatient. Since they approved 2 nights, I had to pay a higher copay. They said if I stayed less than 24 hours, they'd reimburse me,but I stayed like 30 hours. It's all craziness. I would keep that nurse who's helping you on speed dial! Good luck on a speedy scheduling!


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  14. #7
    Gastric Sleeve Member Grace's Avatar
    I have had a gastric sleeve.
    Name
    Grace
    Surgery date
    08/22/2011
    Surgeon
    Portsmouth Regional Hosp
    Join Date
    Apr 2011
    Location
    New England
    Posts
    4,264
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    Default Re: UGH.... My does my surgeons staff lie???

    I'd call the ins company on the days. Mine was just dated for the one day but that was just for the surgery itself. The hospital stay was not a particular set of days because you really never know. I think it's just up to the doc to release you when you are safe to go home.
    Congrats on the approval and sorry for the road blocks but it will all smooth out soon!
    Best NSV - fitting on a kid's amusement park ride with my 4 yr old grandson!
    CFIDS =Chronic Fatigue Syndrome) Also dx with post-bariatric reactive hypoglycemia; and chronic gastritis (both sleeve complications). Permanently disabled.
    Start weight 335, down to 218, up during gastritis. Have accepted there is no way to lose it with my hypoglycemia. Current weight 260. Currently doing 10 day sleeve reset and determined to get back down to my post surgical weight or close to it.

  15. #8
    Gastric Sleeve Member Awesomassager's Avatar
    I have had a gastric sleeve.
    Name
    Amanda
    Surgery date
    11/02/2011
    Surgeon
    Dwayne Smith
    Join Date
    Oct 2011
    Last Activity
    10-26-2018 09:39 PM
    Location
    KY
    Posts
    43
    Said "Thanks" 58 Times
    Was Thanked 6 Times in 6 Posts
    Said "Welcome to Gastric Sleeve" 1 Times

    Default Re: UGH.... My does my surgeons staff lie???

    NPI numbers is a number so they can tell th insurance company who the doctor is doing the surgery.. I was approved by the insurance so I dont know why the hold up now on the appointment... They scheduled my preop for next Monday..



  16. #9
    Gastric Sleeve Member buddyd11's Avatar
    I have had a gastric sleeve.
    Name
    Buddy
    Surgery date
    07/11/2011
    Surgeon
    Dr Thomas Borland
    Join Date
    Jul 2011
    Last Activity
    05-07-2015 10:36 AM
    Location
    Fort Lauderdale Florida
    Posts
    1,105
    Said "Thanks" 39 Times
    Was Thanked 365 Times in 314 Posts
    Said "Welcome to Gastric Sleeve" 246 Times

    Default Re: UGH.... My does my surgeons staff lie???

    Good luck I hope everything works out for you. My BCBS wouldnt pay crap on this surgery so I had to self pay and yes it was done outpatient and I was in surgery by 7am and at the hotel by 3pm. If not for the cath issues I had I would have been to the hotel in less time. Finding a Dr that would do the surgery out patient saved me over 4 grand.



    ********145Lbs Lost what a Journey this has been**********
    Sarcasm is a body's natural defence to stupidity...........

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