Hey, everyone. More questions.

BCBS Alabama has confirmed that I am covered for GRS with no predeterminations, exclusions or any of that crap. I even got confirmation from the manager. Electrolysis is going incredibly well and my electrologist thinks I might be clear by the end of Summer. Which is great and all, but doesn't help me much without a surgeon.

I've been waiting on a response on coverage from Dr. Gallagher of Indiana for at least two months. She's supposedly in the network, but for some reason her manager cannot figure out if I'm covered or not(which I've confirmed, myself, eleven times over). I haven't really done any research on anyone else, because she was highly recommended. But I should really prepare for the possibility that she's not in the network. I don't know where to start and the 'find a doctor' search on their site isn't helping a bit.

So, does anyone have any surgeon recommendations? Based on personal experience? Ones in the BCBS network, obviously.

Dr Loren Schechter in Chicago is BCBS.  He did my BA that I'm happy with and i have a friend who did GCS with him.  So far, she's happy.

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Quote from: Tommygun on January 11, 2018, 03:55:34 PM
I've been waiting on a response on coverage from Dr. Gallagher of Indiana for at least two months. She's supposedly in the network, but for some reason her manager cannot figure out if I'm covered or not(which I've confirmed, myself, eleven times over).

A thought on these surgeon's staffs. . . . they just aren't very good at getting back to you.  I had surgery in August with Dr Bluebond-Langer (NYU). She has GREAT bedside manner but her staff seems overworked and so did every single other Surgeon I contacted for possible surgery. I did think that Dr Gallagher's staff was actually one of the better ones.

Dr BL had 2 RN's who I worked with directly, just before and after the Surgery, on medical  issues and they were incredibly prompt.  I could get a responses on medical issues on weekends, Holidays and even while they were on vacation . .

I don't know how the network rules go. I had my surgery ten miles from home with Dr Oates in Boston. My insurance is BCBS, but all insurers here are required to cover it anyway.

Hugs, Devlyn

Quote from: Gail20 on January 11, 2018, 05:35:27 PM
A thought on these surgeon's staffs. . . . they just aren't very good at getting back to you.  I had surgery in August with Dr Bluebond-Langer (NYU). She has GREAT bedside manner but her staff seems overworked and so did every single other Surgeon I contacted for possible surgery. I did think that Dr Gallagher's staff was actually one of the better ones.

Dr BL had 2 RN's who I worked with directly, just before and after the Surgery, on medical  issues and they were incredibly prompt.  I could get a responses on medical issues on weekends, Holidays and even while they were on vacation . .

I 2nd Dr Bluebond-Langner and she does take BCBS National Blue Network so she should be on your insurance. Her staff was great dealing with Horizon BCBS of NJ and did all the legwork for me. They know how to work with insurance companies on getting things covered.

You need to call and verify but at the time I was looking.
BrownsteinCrane in California and the new office in Austin take that insurance.
There is Dr. Dugi in Oregon.
Dr wittenberg is going on her own. On her website she has Bcbs listed.
Also the one other have listed above.

Ashley

Dr. Meltzer has worked with bcbs of az. Will work through pre certification process.


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Wow! Thanks so much.

I'll check some of these when I get home from work.

Also, I've heard Gallagher has never taken this long to get back to someone. So I am taking that as a fairly bad sign, even though the insurance found at least one of her workplaces in the network.

Quote from: Tommygun on January 11, 2018, 03:55:34 PM
Hey, everyone. More questions.

BCBS Alabama has confirmed that I am covered for GRS with no predeterminations, exclusions or any of that crap. I even got confirmation from the manager. Electrolysis is going incredibly well and my electrologist thinks I might be clear by the end of Summer. Which is great and all, but doesn't help me much without a surgeon.

I've been waiting on a response on coverage from Dr. Gallagher of Indiana for at least two months. She's supposedly in the network, but for some reason her manager cannot figure out if I'm covered or not(which I've confirmed, myself, eleven times over). I haven't really done any research on anyone else, because she was highly recommended. But I should really prepare for the possibility that she's not in the network. I don't know where to start and the 'find a doctor' search on their site isn't helping a bit.

So, does anyone have any surgeon recommendations? Based on personal experience? Ones in the BCBS network, obviously.

Hi Tommygun,

Here's my post from a few days ago about just this thing: https://www.susans.org/forums/index.php?topic=228563.msg2072642#msg2072642

Hope that helps,

Stephanie

Thank you, Steph. It is a big help.

I have one more big question. How assertive/aggressive should I be?

I've been incredibly worried I'd annoy or scare off all the surgeons, so I've been polite and super apologetic in my calls/emails. I can't help but wonder if they think I'm not serious about this. My coworkers keep telling me that I need to be more of a nuisance(although they don't know what my surgery is for). I don't know if their general knowledge is applicable here...

My primary care physician referred me, all I had to do was make an appointment with the surgeon for a consultation. I didn't have to do anything but fight with their voicemail system.

Hugs, Devlyn

Quote from: Tommygun on January 12, 2018, 06:33:19 AM
Thank you, Steph. It is a big help.

I have one more big question. How assertive/aggressive should I be?

I've been incredibly worried I'd annoy or scare off all the surgeons, so I've been polite and super apologetic in my calls/emails. I can't help but wonder if they think I'm not serious about this. My coworkers keep telling me that I need to be more of a nuisance(although they don't know what my surgery is for). I don't know if their general knowledge is applicable here...

Unless your attitude is naturally combative, I have to wonder why you need to ask. These are people who see this condition every day. It's their specialty and they want to help you, not just because they're sympathetic, but because this is their business. If you are simply polite, they should be treating you with kindness and respect. Anyone who does less than that isn't worthy of your business.

In regards to what Gail20 wrote, yes, apparently these offices are really busy, and getting timely return calls is a problem. I get what you mean about being a nuisance. I'm just getting started myself, so I'm not exactly sure what to expect. The first return email from Ting's office was within 24 hours. I returned the message within hours of receiving it. It's now been 2 1/2 days since I sent it, with no response yet. I intend to wait until Monday, which will be about four business days, and either email or call them to follow up. I figure that will show commitment without being annoying.

There is certainly no reason to be apologetic for being you. Believe me, they know exactly what you're going through. They see it hundreds of times a year. In fact, as you suggested, being too apologetic may make them wonder about your commitment. There's a big difference between being assertive and aggressive. Assertiveness is simply being sure of yourself and what you want. Aggressiveness involves going into battle.

So be proud and sure of yourself; be polite and respectful. You should get the same in return. And try to be patient, but check on progress in a timely manner. You'll be fine.

Stephanie

Ah! By this, I don't mean apologizing for being myself. I just mean I apologize for taking up their time and thank them fairly excessively. And I don't send many emails, so I think they end up forgetting about me. So I'm in this awful place where I don't want to bother anyone because I'm worried they'll drop me and I don't message them enough for them to care. So what do I do? Send more messages? Wait another month for another maybe? Whatever I'm doing, I'm doing it wrong. 

And I wish I could do it that way, Devlyn. But my primary care physician is very, very difficult to reach. In fact he's also the most popular HRT provider in Indiana. The best I could do is talk to a receptionist, and I don't think that will help much at all. I've done everything myself up until this point, I might as well finish off.

My surgeon required the following: A refettal and letter from my PCP, a letter from a therapist, and a letter from a psychologist. Im not sure how you can get this done without your primary care physician,  they direct your plan of treatment.

Hugs, Devlyn

Quote from: Devlyn Marie on January 12, 2018, 09:40:43 AM
My surgeon required the following: A refettal and letter from my PCP, a letter from a therapist, and a letter from a psychologist. Im not sure how you can get this done without your primary care physician,  they direct your plan of treatment.

Hugs, Devlyn

This'll be a little tricky for me to manage. My therapist and endocrinologist are in a separate clinic from my Primary Care Physician. My endocrinologist is managing my HRT. My PCP is easy to get along with, and is willing to coordinate with my endocrinologist, so we'll work it out somehow. Actually, I'm not terribly thrilled with my new endocrinologist, and my PCP is willing to take over the HRT, so maybe I'll go that direction.

Stephanie

In my case with blue cross blue shield, I called the main insurance number on the card, and asked to be assigned a patient care coordinator. Typically this is an RN assigned to your case that will help you navigate the system, find surgeons, answer pre cert questions, and be available if the surgeon's office has any questions about coverage or pre-cert.

I'm guessing you're plan is ppo which would not need a referral from your pcp to see any surgeon or specialist.


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Quote from: Brooke on January 12, 2018, 10:43:34 AM
In my case with blue cross blue shield, I called the main insurance number on the card, and asked to be assigned a patient care coordinator. Typically this is an RN assigned to your case that will help you navigate the system, find surgeons, answer pre cert questions, and be available if the surgeon's office has any questions about coverage or pre-cert.

I'm guessing you're plan is ppo which would not need a referral from your pcp to see any surgeon or specialist.


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Wow, thank you Brooke! I had no idea about patient care coordinators. That's very helpful.

Stephanie

I guess my tired brain thought I'd have to make an appointment to get this worked out, but I'll bet I can try to get ahold of him(PCP) and work it out over the phone, but it'll probably have to be via email. Can't hurt to try, anyway. Otherwise I'll be waiting quite some time, because I don't think my insurance covers more than an annual checkup.

And I'm PAC, so I'm not sure what that means as far as how to handle this stuff.

This has been good. Feels like I'm getting somewhere.

Been a few days, but I'll leave an update.

I met with my PCP today and he's helping me work it out with Gallagher. At least, I think he is. I got my referral from him and now I have everything I would need to get approved. If any of these surgery teams would bother to respond, that is. I'm just going to stop by IU Health next week. It's a lot harder to ignore someone in person.

Quote from: Brooke on January 12, 2018, 10:43:34 AM
In my case with blue cross blue shield, I called the main insurance number on the card, and asked to be assigned a patient care coordinator. Typically this is an RN assigned to your case that will help you navigate the system, find surgeons, answer pre cert questions, and be available if the surgeon's office has any questions about coverage or pre-cert.

Well I finally got around to trying this, and they seemed to have no idea what I was talking about. Granted, I tried this through their online chat to avoid using my voice on the phone, so maybe I was talking to the wrong person. I guess I'll have to call and see what happens...

Stephanie