HealthNet HMO Southern CA - consultation?

sourcherriex
on 8/11/11 3:13 pm, edited 8/15/11 3:55 am - CA
Update: I just got my approval finallyyyy! Thanks everyone for all your help!

I posted this on the insurance forum but it doesn't seem too populated over there. I figured I'd try here also.

I'm having a really hard time getting my insurance to approve my consultation request to meet with my surgeon. I have never had an HMO until now (I had to switch from a PPO to get coverage for WLS) and I'm finding this to be incredibly frustrating. I can't even get a CONSULTATION! They have kept it "pending in the final stages" for over a week now! I mean, if this is how long it takes just to MEET the guy, I can't even imagine how long it's going to take to get any kind of surgery approved.

I'm not really sure what the problem is. I have a BMI of 51 - Clearly I am a candidate for this request. My PCP's office is completely frustrated and baffled too. They keep e-mailing and getting no response. Has anyone else with HealthNet HMO had these kind of issues? Is this going to be a really long road to approval?

Thanks in advance!
acbbrown
on 8/12/11 11:29 pm - Granada Hills, CA
I had an HMO (kaiser) and I didn't get to meet with the surgeon until 9 months after starting the process - there was a team of other people and classes I had to go through first.

Not sure what HealthNEt does, so I can't be very helpful, but hope it resolves soon!

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Kathie L.
on 8/14/11 2:07 am - Castaic, CA
I have Facey through Anthem BlueCross and I had to attend 6 months of classes, and many tests, etc. but after 11 months I finally saw Dr.Quillici and two weeks later had surgery. Be patient; you'll get there. Dr. Q. was great.
sourcherriex
on 8/15/11 3:37 am - CA
 Thanks for your reply! I've heard only good things about him. Thankfully my insurance doesn't require any classes and I've already had any tests they could possibly want. I'm trying to be patient but it just feels like they are slacking on purpose at this point, you know? I'm worried it's because I am going for the VSG and they only cover it if you can't have RNY for some reason.
newbarb2
on 8/14/11 2:19 am
The State has an agency that can assist with issues and concerns regarding insurance companies.  Here is the link:

http://www.hmohelp.ca.gov/

Good luck,
Barb
 
    
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