Just switched to healthnet - what is the deal?

So...IF someone were to just have switched to healthnet and they wanted to have gastric bypass - what is the story?  Member kept the same PCP they had from previous carrier (Blue Cross of CA).  Is this a difficult authorization to get?  A friend of mine may be interested and I want to give her the true story as to how easy or difficult it will be to get authorization.  Interested in hearing from you guys! Hugs and Kisses as always! Shelley

Hey Shelley! It kinda depends on if it is Healthnet HMO or PPO. We are in the same boat. My husband has decided to look into having the surgery...we just switched from Blue Cross PPO to Healthnet HMO with my job...we have the same PCP...BUT...even though Healthnet says they cover the surgery...they only pay a set amount for the surgery...and it is up to the medical group that you belong to wether or not they will do the surgery for that amount...which I am being told is a very small amount. There is also a required 6 month diet before approval. We may just wait until open enrollment in October and change back to Blue Cross and then he can do the surgery in January. I got an approval in 3 days with Blue Cross...and we would like to have Dr. Oliak do his surgery as well. Okay...enough of my sob story...LOL!!! Hope you are doing good!!! You look HOT girl!!!

Thank you my surgery sister!  Could we have MORE incommon?  Kim, my partner, is also mentioning it and she is actually who I am asking for.  I didn't want to disclose - but again...so mu*****ommon I had to! - - Either way - we want to ensure that IF she choses to go this route that she will not have trouble getting approval.  I will be interested to see what our PCP says and my surgeon, Dr. Ali, who I just love and would trust with my person! - - Let's keep each other posted. Thanks for the "hot" comment - I'd like to say I don't love it - - but that would be a lie! :) Hugs!!! Shelley

YES...lets keep each other posted!

Lisa, Dr. Oliak is contracted with HN.  It once again depends who the medical group contracts with. Liz

Hi Liz, Yes...Dr. Oliak told me he uses HN...BUT...unfortunatly with our HMO...we can't pick our surgeon...it has to be an approved one within our medical group...or at least thats what HN is telling us. So...we may end up just waiting and switching back to PPO so we can use Oliak. Well see. Thanks!!!

I had Healthnet HMO with Monarch as the provider.  I rec'd approval for the referral to Dr. LePort's office within a week after visiting my PCP.   When the surgeon's office sent in for approval for wls, it was approved in less than a week.  There was no requirement for supervised diet.  For me, it couldn't have gone any better.  Hope your friend finds it to be the same.

Hi Jan, Thank you for your response.  That is certainly encouraging! Good for You! Good news for US!!!

I have HealthNet HMO and so far everything has been smooth.  I saw my PCP the middle of April.  Saw the surgeon the end of April.  The psych in the middle of May and the Nut the end of May.  My paperwork was all submitted on Friday and I am currently awaiting approval.  I didn't have to do a six month diet or jump through any hoops.  Hopefully, I will be approved.  It has been far easier than I had ever imagined.  Lola

Excellent Lola! Thank you for sharing the encouraging path.  I appreciate it! I'll be looking out for your "I'm approved" notice! Best to you!