HealthNet HMO California - consultation?!

Update: I just got my approval today 8/15! It took them the entire 10 business days. I'm off to see Dr. Quilici on the 24th!

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!

I started the process with Health Net in December 2010 and I am still waiting to get surgery approved.  This is for a gastric sleeve.

 I'm going for the sleeve also. I know they only will cover it if you can prove you can't have the bypass. I was kind of hoping they wouldn't give me any crap because my BMI is so high. When I spoke to them on the phone I was told it shouldn't be a problem. Have you been officially denied? I am worried they will deny me and I will have to appeal. I know they cover the DS so I don't understand why getting the sleeve is so much more difficult. I guess I could always try and get approved for the DS in 2 parts and just never get the second part, lol.

Thanks for your reply. :)

I have a 51 BMI and yes I was denied for the sleeve.  They said I qualified for the RNY or LapBand but not for the sleeve.  The letter basically said.....you have no reason why you need a sleeve over the others.

I had to appeal and am currently waiting on that appeal.

As far as the initial consultation.....had no problem getting that.  My bariatric surgeon (Dr. Wetter) and my PCP are in the same medical group and actually 2 doors down from each other in the same building.  That wasn't bad....just took about 3-4 weeks to get the referral.  The surgeon would not allow me to make an appt though until they got the referral completed...and then obviously I had to wait about 2-3 weeks after that to finally be seen.

It can take a while. 

HMO timeframes are completely ridiculouis. And you've been dealing with the denial for almost a year now! I'm so sorry. I saw your post on the VSG forum as well. You definitely deserve some good news soon. I wonder if I'd be better off trying for the DS in 2 parts. I don't even know if they will approve a 2-part surgery. We will see what happens. I have called (annoyingly) every day this week trying to get them to go faster. They said if it's not done on monday I'm free to raise hell, so we will see. I didn't switch to this stupid HMO to not fight my ass off. :P