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Surgical Weight Loss - A Journey to a New You, Now Available at LMH !

Surgical Weight Loss - A Journey to a New YouDr. Mark Patterson is a Board Certified General Surgeon. He is a graduate of UT Memphis Medical School.  He has been with Greeneville Surgical Associates (Laughlin Medical General Surgery) since 1995.  Dr. Patterson has been doing the Vertical Gastric Sleeve procedure since December 1, 2011. To date, he has performed 19 cases, all of which have been extremely successful with several patients losing over 100 pounds. 

The Bariatric Team consists of Dr. Mark Patterson; Demaris Dickenson, RN, Bariatric Coordinator; Ashley Head, RD Dietitian; and Tracy Green RN Wellness Coordinator. The team works together to coordinate pre & post-operative care.

The Sleeve Gastrectomy is our newest surgical weight loss procedure. The Sleeve Gastrectomy involves permanently removing approximately 85% of the stomach. Research has shown that removing this portion of the stomach reduces a hormone called ghrelin which causes hunger. Therefore patients not only feel full after a small amount of food, but also do not often crave food. It is not uncommon to hear Sleeve patients say that they have to remind themselves to eat. The other great benefit of the Sleeve Gastrectomy is that there is no malabsorption of nutrients and patients have fewer problems with vitamin deficiencies including Calcium, Iron and Vitamin D.

For more information and to register for a monthly Bariatric Informational Seminar, contact Demaris at 423-787-7100 or by email demarisdickenson@lmhcare.org.  


Frequently Asked Insurance Questions

Why does it take so long to get insurance approval?
It takes 2-3 weeks from your last appointment before all of your dictation is ready to be sent in. Once it is sent in to your insurance, it can take anywhere from 1 week to 6 months before an authorization is received, depending on your insurance. Some insurance companies require the documentation to be reviewed by their medical director. Because of this, they can get backed up on reviewing the documentation. Most insurance companies have specific requirements when it comes to bariatric surgery. They will, on occasion, request additional information from either you or your primary care physician. You should contact your insurance company to see what their requirements are.

How can they deny insurance payment for a life-threatening disease?
Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or “treatment of obesity.” This exclusion can often be appealed when the surgical treatment is recommended by your bariatric surgeon or referring physician as the best therapy to relieve life-threatening, obesity-related health conditions, which usually are covered.
Insurance payment may also be denied for lack of “medical necessity.” A therapy is deemed to be medically necessary when it is needed to treat a series of life-threatening conditions. In the case of morbid obesity, alternative treatments – such as dieting, exercise, behavior modification, and some medications – are considered to be available. Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

If I am denied for the surgical process, what would my next step be?
If you would like to appeal the decision, call your insurance company and ask what their appeal process would be. You will then need to contact your primary care physician and have them assist you in any documentation that would be needed to help with your appeal. We have not seen you in our office at this point and therefore would not be able to help in your appeal.

If my insurance company denies me for surgery after I have had my initial visits, what would my next step be?
Once we receive the denial letter from your insurance company, we will begin to work on the appeal process. We will contact you to let you know what additional information they have requested. You may need to contact your primary care physician to request the information and have it sent to us.

What can I do to help the process?
Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide “necessary” information. Letters from your personal physician and consultants attesting to the “medical necessity” of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery. All of this information should be sent to Laughlin Surgical Weight Loss Center.

Why are there out of pocket expenses when my insurance company tells me they pay for everything at 100%?
Insurance companies pay for the services that are billable to them. Our physicians do not participate with all insurances. For the non-participating insurances, you will be required to pay for your service at the time of service. There are other services that may not be covered by your insurance company.

What if I have a pre-existing clause on my insurance policy?
You should check with your insurance company to see if your policy has a pre-existing clause. If it does, find out how long you must wait and notify us of this time frame. You will need to wait until the waiting period is done before scheduling any appointments or having your surgery. You should also let your insurance company know if you had other insurance up to the time you obtained insurance thru their company. If you had other insurance prior, the insurance companies sometimes will waive the pre-existing clause.


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