Any Suggestions?

I have been struggling with my ins company about getting a DS consultation and surgery. Thet absolutely will not referr me to an bariatric surgeon that performs it bc all the surgeons are out of network. I have been going from my doc's office, to medical group, to ins company, and even to the surgeon's office to get this to go through. They all send me to the other and this is getting VERY frustrating bc it has been happening for ten days. I don't know what to do anymore. I feel like I have exhausted all avenues and I still come up empty. Bascially I have to see one of their doctors and get a surgery they perform. I know the DS is for me but I can't get them to see that or even authorize a consult with a DS surgeon. I know I'm allowed an out-of-network consult if there is no one in my plan to perform the specific surgery. But how do I get them to budge. And the sad part is.... they aurthorized me to see a bariatric surgeon so I can't file an appeal to get what I need. Any suggestions from anyone whom had to fight their ins company would be very welcomed.
Adia

I bet you have already done this but I went to my insurance companies page and found one in my network even though it was many states away I did my consult by phone and flew out for my surgery. I have Aetna insurance. I know what you mean by saying you know the DS is for you I felt the same way and would of settled for nothing less. Best of luck.

 

Trish

Because I'm state insured I have to stay in cali. There are also drs here so I don't get what the hang up is.

This happens all the time. I think you have 2 options:

 

1. see the iin-network surgeon they are willing to authorize. Request the DS. He/she confirms he/she does not perform that operation. Then go back to the insurance company with that information and insist on the out-of-network consult with someone who does do the DS.

2. File a grievance. Yes, you CAN do this! You are being denied a covered service. the fact that your insurer doesn't have an in-network surgeon to provide that service is their problem, not yours. And of course they aren't budging, why should they. If you cave in, they save money. It's all about money, and not about what is in your best interest.

Larra

I think I just might file a grievance. That is something I haven't done. Ty

Larra, I filed my grievance today and the lady I spoke with said I am going down the right avenue. Thank GOD for vets like you. Because us newbies are clueless.
Adia

I was able to just write a letter to my insurance and ask them to approve my surgeon as "in network" because there  were no surgeons that did the DS....