Need Aetna HMO Primary Care Provider

Hi, I'm looking for a sympathetic primary care provider who will give me a bariatric referral without a whole lot of hassle. washington, dc metro area. thanks

Hi, I had my Pcp give me one with no hassle. Dr. So is leaving the practice but there is 3 more doctors and Dr. Lee or Dr. Casas are nice doctors too. They are located MD 8317 Cherry Lane Laurel, MD 20708 301-776-0070 Good Luck! Cira

Hi CB, I didn't need a referral, but I would think that if you have co-morbidities, most primary care physicians would give the referral without too much hassle. I'm sorry I don't have any information to offer, but I wanted to encourage you not to give up and to welcome you to the board Take Care, Terry

Hello C.B. Call Dr. Fullum's office and ask them for the name of the physician they work with. Its a female and they are on the same floor at Provident Hospital. Since you have an HMO, in the State of Maryland, you can't be turned down --so keep that in mind as you go through the process. Move Forward Peace,

Hi, Question for you... You mean that if you have an insurance that is HMO in MD there is no denial? Just curious if that is what you meant? Thanks! Cira

That is exactly what I meant. I see we have the same surgeon. I believe I have the exact wording of the Maryland statute on my computer at home. I'll find it and cut and paste it to you for future reference. As long as you are over 18 and meet the National Institute of Health definition of obesity and meet the BMI -- you're in like flint. You can hit me directly at [email protected]. You look familiar to me.

Here is the section in the Maryland Code: Maryland Code : INSURANCE : TITLE 15. HEALTH INSURANCE : SUBTITLE 8. REQUIRED HEALTH INSURANCE BENEFITS : § 15-839. Coverage for treatment of morbid obesity. § 15-839. Coverage for treatment of morbid obesity. (a) Definitions.- (1) In this section the following words have the meanings indicated. (2) "Body mass index" means a practical marker that is used to assess the degree of obesity and is calculated by dividing the weight in kilograms by the height in meters squared. (3) "Morbid obesity" means a body mass index that is: (i) greater than 40 kilograms per meter squared; or (ii) equal to or greater than 35 kilograms per meter squared with a comorbid medical condition, including hypertension, a cardiopulmonary condition, sleep apnea, or diabetes. (b) Applicability.- This section applies to: (1) insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are issued or delivered in the State; (2) health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State; and (3) managed care organizations, as defined in § 15-101 of the Health - General Article. (c) Coverage - In general.- An entity subject to this section shall provide coverage for the surgical treatment of morbid obesity that is: (1) recognized by the National Institutes of Health as effective for the long-term reversal of morbid obesity; and (2) consistent with guidelines approved by the National Institutes of Health. (d) Extent of coverage for other necessary surgical procedures.- An entity subject to this section shall provide the benefits required under this section to the same extent as for other medically necessary surgical procedures under the enrollee's or insured's contract or policy with the entity. [2001, chs. 493, 736; 2004, ch. 486; 2005, ch. 301.] Here is the web link http://198.187.128.12/maryland/lpext.dll?f=templates&fn=fs-main.htm&2.0

NaDine, Thanks for the imformation. I really appreciate it. Have a wonderful day. Cira

Thanks Nadine!! this is really great information!

BTW, Dr Fullum moved offices to Baltimore.. He's no longer at Providence.. I went there specifically for him to do my surgery, and in the 2 years it took me to get ready, he moved just before this summer.. Dr Rickford is handling the surgeries now. Dr Tapscott is the female in the office if that is who your talking about.