In July I contacted 1-800-Get-Slim (before itchanged to Get-Thin) to show my interest in their Lap Band procedure. They tookdown my medical insurance information and set me up for a consultation. On July29 I went in for a consultation. After the info seminar I met up with adoctor and afterward assigned a consultant by the name of Pauline Garcia. Shespoke with me and told me that my insurance would cover everything includingthe exams I will need.in August I was scheduled for an endoscopy and othermedical tests.in September I was sent a letter from my insurance stating theydo not cover the Lap Band procedure. I called Pauline many times. Left messagesbut there was no reply. Finally after weeks she called me back and said to faxher the letter from my insurance. I did this and again began another round ofcalling her to follow up and leaving messages with no response. Since I got noresponse I filed an appeal with my insurance.
When Pauline finally contacted meshe me that they had filed an appeal. I received another letter stating againthey would not cover the procedure. I was then contacted by Pauline stating wecan now do something else. They would check me for a hiatal hernia. If I dohave it, they would get approval from my insurance to do the surgery and then Iwould pay them $3500 and they would do the Lap Band at the same time. I went infor another consultation with a Dr Madan in Long Beach. He met up with me verybriefly and asked me if they had found a hernia with my endoscopy. I said Ididn't know. And he tell me that "we're gonna go ahead and get this goingfor you and get you approved. Shouldn't be a problem". That was prettymuch it and then he told me that my consultant would contact me. After about 2weeks she calls me and tells me I have to have another endoscopy. I ask her whyI have to get another one if I had already gotten one done. She says because"before they weren't looking for a hernia" but now "sincethey're finding a lot of people have them" they are going to do anotherone.
I was not too happy it especially since I would go under sedation onceagain. But I figured that if that's what it takes to get the procedure done Iwould do it. I also I agreed about the money. I had gotten a federal tax refundand had no problem paying it. She told me to send a cashier's check to them. But then I said, Shouldn't I wait until it's approved by my insurance before Isend the check? To which she replied, Oh yes that's right. Just wait. I went infor the tests in February. I thought I was only going in for the endoscopybut they made me take all the tests all over again. This includes, ultrasound, ekg, urine, blood tests. I asked if I would have to do all the tests again andthey told me I had to since it had been a long time since I gotten them doneeventhough it had only been a few months. Now there are a lot of claims filedwith my insurance which my insurance had refused to pay. My insurance is sayingI am responsible for all which totals up to $10,000 or more. And that is onlyfor the tests. I then got a call from Pauline Garcia stating they had"found a hiatal hernia" in my tests and she said "don't worry, that's actually a good thing". She said it would take about 5 businessdays to get an approval from my insurance. But weeks passed and I received noresponse. I continued to call and leave messages.
When she finally called meback she told me not to worry because they have been following up with myinsurance and so has Dr. Madan. On 2 occasions I recieved calls from the WeightLoss Center/Top Suregeons in Beverly Hills. One of them stated she wanted tocomfirm my email and taht was the last step before sending my information to myinsurance. I got a little annoyed and told the person that I thought I wasalreayd waitinf for a reply from my insurance. She did not have an answer andshe only told me that she would have my conultant contact me. This neverhappened. I called Pauline Garcia's businness phone, which is the number I havebeen calling on June 25. A female answered and stated she was notPauline, she was Diane and that she did not know Pauline but she only knew thatit used to be her business phone. I have called Weight Loss Center and they cannever give me an answer. You either transeffered from person to person orstated someone will call back or you are sent to a voicemail.
I have reasons to believe that they knewfrom the beginning that I would not qualify and were merely seeking to filefalse claims with my insurance for their own financial gain. I also believe the"hiatal hernia" is nothing but a scam pulled by them and when theyrealized my insurance would not cover they no longer desired to work with me. Iwould say I want them to proceed with the procedure but after finding out thatthe reason insurance companies are not approving is because 2 of the doctorsthat are the owners or president of the facility had their license revoked, Idoubt my insurance will approve. At one point when I was sitting in the waitingroom I heard 2 doctors speaking about the "hiatal hernia" exams. Theywere speaking about who would pay for what and "how is this going to workout". Unfortunately, there were so many people in the waiting area that Icould not hear what they continued to say.
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