[Debs]

I spoke with my ins company yesterday. My surgery req was supposed to be completed by Thurs., but for whatever reason was not. When I called yesterday they tried to tell me they were waiting for clinical notes...funny, because that's what my surgeon said they were going to say to try and get out of processing my request! So little demure me (haha not me!) told them so! I said, "funny you say that -- my dr said you would. Can you put me on hold and go thru my file again? I guarantee you will find what you are looking for!". She did - not to my surprise! So on Monday I will -- no doubt -- get a denial, I will appeal and in 10 days it will be approved. Then the next stage of battle begins, which is....

I cannot find ANY evidence that the surgeon to which I was referred is board certified. His office says he is, but ASPS says he is not. And sorry -- I'm not comfortable with that. For all I know he's a podiatrist! The girl on the phone at my regular dr's office said to me "a friend of mine had her breasts done by him and was very satisfied". OK, great for her -- maybe he just had a good day! I'm not willing to take that risk. I figured my best plan of attack would be to let them deny it and me appeal and then they approve it, and THEN I go after them and say...Hello....he's not board certified....can you give me someone who is? If not, are you willing to give me something IN WRITING which states if ANYTHING goes wrong, YOU (my ins co) will pay for ANY and ALL reconstructive surgeries to correct his mess...at the surgeon of MY CHOICE and at the hospital of MY CHOICE?

Of course, they will say no, and I know this. But they may also rethink sending me to someone who is not certified...and send me to someone who is.

We'll see....cross fingers...I am!!

Debs

[FemmeMode]

Remind me what plastics you are doing...is this the "reconstructive" TT?? without the muscle tightening, etc??

I hope all goes well...as you go thru this adventure!!
Good luck!

[fr1endly2]

Well ill keep positive vibes going for you to hear
good news on this matter.
Waiting stinks

[DocSanae]

Hope things work out the best way for you.
((((((((HUGS))))))))

[droliver]

Debs,

What is your Doctor's name? I can check the board-cert. or training background thing out for you if you like. He/she may in fact not even be a plastic surgeon at all despite being "board-certified" in something.

Read these blog entries on this for some background on this issue:
Plastic Surgery 101: ENT (ear,nose, & thighlifts?) nailed by California for playing Plastic Surgeon

Plastic Surgery 101: A monster in Munster... (a very painful Plastic Surgery pun indeed)

Plastic Surgery 101: Who's a Plastic Surgeon? (and who is not)

cheers
Rob Oliver Jr. MD

[Debs]

Dr. Oliver, that would be GREAT if you could check for me...you have have better resources that I do. I've called the State of CA, and he does have a medical license, I called the Bd of Plastic Surgeons, but they don't have him listed. We always hear people tell us, "Make sure your surgeon is board certified"; it just seems odd to me that my own ins co would send me to someone who is not certified! I know as far as ins goes, it's all a game of dollars and cents -- maybe they see it cheaper in the long run to pay for a non-certified dr's screw up a few times than to pay a certified surgeon's fee straight across the board. My fear is that he's a podiatrist or an opthamologist and just because he may have taken a class i med school considers himself a "specialist" in the field.

Anyway...'nuff said. His name is Dr. Jacob Saleh in Tarzana, CA. I found another Dr. Saleh in Agoura Hills, close to Tarzana, with the first name an unpronouncebble starting with a "J" but he's an internist....could be the same guy I guess, but still not a bd certified plastic surgeon!

Thanks in advance for your help...I appreciate it!

Debs

Originally Posted by droliver

Debs,

What is your Doctor's name? I can check the board-cert. or training background thing out for you if you like. He/she may in fact not even be a plastic surgeon at all despite being "board-certified" in something.

Read these blog entries on this for some background on this issue:
Plastic Surgery 101: ENT (ear,nose, & thighlifts?) nailed by California for playing Plastic Surgeon

Plastic Surgery 101: A monster in Munster... (a very painful Plastic Surgery pun indeed)

Plastic Surgery 101: Who's a Plastic Surgeon? (and who is not)

cheers
Rob Oliver Jr. MD

[droliver]

Dr. Saleh is not listed as being board certified by any of the Amer. Board of Medical specialties. There could be a few reasons for that.

1. there's some oversite on the ABMS website (doubtful)

2. he's fully trained here in the US but never took or passed his boards

3. he trained overseas and is not eligible for board certification.

The fact he's not listed by the ABMS is a red flag when someone porports themselves to be boarded in Plastic Surgery (it's actually against the law in many states). He may in fact be both qualified & well-trained and there are some of the finest surgeons in America who are not eligible for board certification.

You need to ask:
1) Where he trained (US or abroad)?
2) What he trained in (was in Plastic Surgery)?
3) Is he board eligible or certified by the American board of Plastic Surgery?
4) Does he have operating privledges at a hospital in Plastic Surgery? (ie. not just doing surgery in the office)

You can check anyone's board status thru ABMS Home Page wher you have to register (for free) and can search for anyone in any specialty & it will show what they are board-certified in.

cheers
Rob

[FemmeMode]

This is disturbing....
Thanks Doctor Oliver for being soooo great, and checking this out for us!! And thanks for the website.

[fr1endly2]

DEB did you get any info?

cool information doctor OLIVER!
thanks

[Debs]

I did, and like I said before....I'm just not comfortable with this at all. I'm not sure where everyone is, but in California we have insurance for low income families called Med-Cal. Similar to Medicaid, but different (if that makes sense!). To preface what my point is, I should give a little background...

I may have mentioned in past posts that I have a disabled daughter-she is 16 and is mildly physically and profoundly mentally disabled by a rare genetic disease. To put it simply, I have a 4 year old in a 16 yr old body -- tantrums are HORRENDOUS, if you can imagine having a 125 lb girl throwing herself on thr floor like a 4 year old, among many other challenges. She had a kidney transplant last Dec 12; prior to that she had been very ill, in and out of hospitals for the last 4 years. I had my WLS on 12/30/02. In Nov '03, I rushed Chelsea to hospital and it turns out she was in congestive heart failure and BP was 232/198 - her kidneys were failing - that's when we found she has chronic kidney disease. At the same time, my mother had been hospitalized since Aug '03. My father is deceased, I am divorced, I have 3 brothers and 2 sisters scattered across the U.S., so all of this fell onto me to handle. At the time, I was employed full time and was a full time student. I was OK with mom being in hospital, but when Chelsea went in that was it -- couldn't handle it. I quit school for a time but I was still working.

When my mom came home, she was still unable to work after being hospitalized for 7 months. Chelsea was also unable to go to school because of illness. I quit my job to care for them, therefore losing my insurance. I did go back to work part time, but because my mother is still very ill and, even post transplant, Chelsea has a RIDICULOUS number of dr appts. I need to be able to have a flexible schedule to care for my family.

Then, after all of this, I GOT SICK! We all know what happened there -- hospitalized for 42 days, nearly died, so on and so forth. While hospitalized, I became eligible for Medi-Cal. I am the sole provider for 3 people, I work part time, and earn -- well, lets say "not a lot".

Now I can go on with my point of this post....

Medi-Cal patients are looked upon as "less than". We don't get the "good" doctors. We have to fight for our benefits. This is the problem I am having. They never thought they'd have people like me on Medi-Cal -- people who enjoy a good fight and know enough about medicine and how insurance companies work. I've never been to med school, but what I've been thru with my family, I probably know a lot more most.

OK, so...moving on.....I think that's a big reason why I'm getting the care (or lack thereof) from my insurance company and medical group They figure most people on Medi-Cal are unemployed and un- (or under-)educated and don't know the process. They don't know they can appeal a denial, they don't know they can fight for what they want. You'd think by now they've seen my name across the desk enough times they'd just say, "oh God, she's back again...just do what she wants to avoid the hassle. I don't want to deal with HER agan!".

My surgery req is in "medical review", whatever that means......