whats next

Do u know that I'm out  $400, because my pcp and dr shebanis office  didn't do their job, they told me that they took Amerigroup which is a medicaid provider, they were submitting for approval to the insurance company last week, but gave me the run around all last week, and didn't even bother to call me to let me know that Amerigroup did not accept the request for them to do the surgery because they are out of network.  How did they not now that they were out of network!!!!  They are non-par, which means they don't have a contract with Amerigroup! They suck, they found this out last week on Friday and haven't even bothered to call me to tell me!!! After my sorry ass pcp and that sorry ass office in ocala weren't calling me back, my wife and I called medicaid (Amerigroup), and they told me that Dr Shabani is out of network, and that they do not cover out of network dr's .   all I know is right now, at this sec,  I'm sick in my head to know that these two dr's offices can make such a big mistake and now I'm out of $400 and having to start all over. why me i always have the best of luck can any one help.

You should be able to get copies of any pre-op tests and such that you have already had done. To send to your new surgeon.   I am sorry you had to go through this -- but one must always verify what a doctor's office tells them with the insurance company.  There are just too many places for the information to get messed up and insurance stuff sometimes changes pretty quickly.  

it was nutritional eval $150 and psychological eval $250 things medicaid didnt cover not only that im trying to work with another dr and she said amerigroup medicaid wants 1 year of weight loss i dont know what to anymore what i mean is i tryed all kinds of things only for it to stop working and gain more then i lossed.i dont know anymore .i do have about 8 months of dieting but it go's back from 07 till now

You need to call your insurance and ask them to send you the policy on WLS.  Some require a supervised diet and others do not. 

Red

ok how does that work, do you have to be on a 6 month consecutive diet, or can it be split up?  I have a 4 month diet plan I was on, and a couple of 1 month diet plans with different doctors, but there's a year in between the two.  I was hoping you might now...

Hi Eddie...I'm a Medicaid case manager for the Tri County area (Polk, Hardee and HIghlands).  I can tell you this - straight Medicaid requires you to have 12 months of consecutive nutritional counseling sessions prior to surgery; however sometimes that 12 months can be split up depending on the type of counseling you had (i.e., proof of weigh****chers meetings, etc).  So, call Amerigroup and ask them what the criteria is.  Or log on to their website!  https://www.myamerigroup.com/english/pages/welcome.aspx

Good luck!~

Have you thought about maybe changing your medicaid plan?  I have been told that it is a lot easier to deal with Medicaid/Medipass.

Sorry this happened to you and Good luck with what ever you decide to do.

What all did you spend the $400 on? If it was doctors office visits, you should be able to negotiate/fight those costs down since they told you they took your insurance when in fact they didn't. Don't let them take advantage of you. I say fight the bills!