TennCare Select Help

I need information from anyone who has dealt with TennCare Select. They have approved me to see an in-network surgeon, but to be honest the closest one is in Clarksville and I have not heard the best of things about this surgeon nor the hospital. Is there anyone who has successfully gotten approved for an out-of-network surgeon with TennCare Select. Thanks for all your help.

I have Tenn Care select had my sugery on 12/02/04 first thing find an out of network sergeon like ( Dr. Spaw ) my surgeon lol he's the best. he's at the Metabolic Surgery Center at Baptist Hospital there in Nashville give them a call 284-7960 or check out their web site ccfos.com I think lol good luck If you have any other ? just ask someone on here is bound to know right. good luck.

Thanks Debra so much. When you asked for approval through TennCare were you intially denied? And what did you do after you were denied? I have asked for a case manager and I'm in the process of appealing to get an out of network approval. How long did it take for you to get approved for out of network? Once again thanks for any advice you can give me.

well I was denied then my Dr.s office was supposed to appeal (spelling not my thing lol) for me but I have no patience so I appealed myself.(just call the # on the back of your Tenn Care card and ask for the appeals office) I hade 2 case workers the first was nice the 2nd was very condencending she told me I should just try another diet!huh as for out of network my Dr. refered me to Dr. Spaws office for consualt and surgery and they gave me a call. Did you call Dr. Spaws office talk to Ellen Bell shes the Insurance person she knows the in and outs to it. It took me about a year to get approvel just keep going my advice to anyone don't give up and call everyone If you bug them enough finaly you will get someone to tell you how to do it all right . hope this helps you.

Thank you so much Debra. I called Ellen a couple of months ago and talked to her and told her what insurance I had and she told me that they do not contract with TennCare but to file an appeal and request an out of network surgeon she said it might not work but to try it anyway. Well thank you so much for the information.

Have you checked with Dr. Agbunag's office at Skyline Medical Center? Terri

Thanks for your suggestion Terri. And yes I've called Dr. Agbunag's office and his nurse told me they were no longer accepting TennCare for Gastric Bypass. I guess it's because TennCare pays so little to have it done. But thank you for your suggestion

Larry, I too am a TC Select patient and was referred the beginning of Jan 04, was denied, appealed and had surgery on April 2, 04..........fight and don't stop. DO NOT accept no, and do the leg work yourself. WRite emails, even write the appeal letter for your doctor to sign. Do what ever it takes and get it done fast. Dr. John Husted and his partner Dr. Spaw are the only doctors who do the Duodenal Switch in the state. If that is what you want then damn well stand up and go for it. It can be done, I know because I did it. Debra Fielder............see my profile on www.ccfos.com and others, who have had this surgery. -78 pounds and counting.

Hi Deb thank you so much for writing. Was Dr. Husted your surgeon? He is the surgeon I requested from my PCPs office but was denied to see him, thats when i got the list of TennCare surgeons that do it. I have had a couple of close friends have surgery with Dr. Husted and i have heard nothing but wonderful things about him and his staff. I go to their forum often to read the inspirational advice everyone offers each other. I would be grateful if you could tell me exactly how your appeal process went and how you got it going. I don't trust my PCP to do anything so i'll more than likely have to do it myself and any advice would be wonderful thanks a million.

I did have my surgery at clarksville and with dr hruska even though she can not been very nice, but the biggest thing if you do have to use that location is while you are at the hospt have someone stay with you, they do allow it.