IEHP/medi-cal help/ self pay options? So lost.
Since I have been a full time student the last 10 months I'm on IEHP/medi-cal, my primary care suggested I go through the process to get surgery and referred me to a nutritionist. The nutritionist did the 6 month assisted weight loss program and submitted his notes to the insurance company and my primary care sent the referral to see the surgeon. I was denied, I called the insurance company to appeal it. I then called the person in charge of referrals at my doctors office and she told me that basically she has only seen a handful of patients get approved. I've recently graduated and I have a state board exam next week and my school is now working to get me working as soon as possible. So now I'm wondering if I should bother trying to fight with IEHP or find some way of paying for it myself? If so I'm lost at where to start since really the only thing on my credit is my student loans. Any advice/help appreciated. thanks.
They sent a letter stating I was denied because I do not have records showing I've been overweight the last 5 years. I called them and explained I have been living in Oregon the last 6 years and I could have records sent over since I have in fact been overweight for 12 years. The lady on the phone told me that would not work, my records would have to be from this state over a 5 year period.
Well who knows there are a lot of people who interpret that differently. I would get the records and submit them anyways. You have nothing to lose by trying, and appealing the decision. I see no reason that it would make any difference where the physician is located to document your weight. Unless you have only lived in your current state for just a month... On the other hand I don't have insurance coverage for bariatrics and I paid out of pocket, it sure was nice not to jump through all the insurance hoops to get the surgery. I'm assuming you have gotten some kind of medical certification... which choosing your place of employment for the insurance coverage would greatly benefit you. Especially jobs with or funded by the city, county, state, or federal, or a large company. These are the kind of places that will likely have the best bariatric coverage. Maybe your supervised weight loss will already apply to the new plan? Good luck!
Outpatient VSG 9/5/14
with Dr. Umbach in Henderson NV
I've pretty much given up on IEHP, I got my cosmetology license last Friday and I've already had a few interviews this week. So it looks like I'm going to be looking into some sort of self pay option, the hours I'll be working in a salon just don't give the flexibility to play the go to x amount of doctors this week based on when the insurance company says to go game. Hopefully this all works out.
I'm still working on it. Iehp required me to go back to my primary care for 6 months and they just resubmitted a referral Friday I asked them to send over also a letter of medical necessity and copies of my weight from my charts going back to age 7 when I became obese. I'm also on cpap therapy as of April with newly diagnosed severe sleep apnea so we'll see what happens.
Hello, I'm new to this but I have so many questions if anybody can please help ? Well I have IEHP, and I've had to do 6 months of weigh****chers and I've had to check in with my primary doc once a month, I didn't do good @ weigh****chers I gained and I lost, can that be a problem? My consultation with a Bariatric Doctor has also been approved.. They gave me an appointment to attend an informational seminar first, mailed me paper work to take for that day and said after that seminer I would get to have a "face to face" lol appointment with the Doctor SO.... Does any of this sound familiar to anybody??? If so what should I expect next? Will the 6 months of weigh****chers (and being supervised by my doctor) be enough? And how long will it take for me to finally get my lapband surgery?
Hockeymom87 · 0 replies · 611 views
