need to vent CRAPPY HMO again

the saga continues........ I finally got a referral to a surgeon. YAY. BUT the surgeon doesn't offer the procedure I am looking for. I go back to my crappy PCP and ask for a referral to one of two Dr who are both in their system as approved Drs and explain why, he agrees. After two weeks I call and ask for a status they have no answer so I call the Dr and says they won't approve it because the insurance doesn't cover the procedure I want. I explain that I know that and am willing to fight the insurance co but cannot until I get the referral. he resubmit it. It gets denied on Sept 25th, I don't find out until yesterday and they have reason why or recourse I can take. if I wasn't so hellbent on making their life hell I would just throw in the towel on this whole WLS stuff.I often wonder if its really worth all the hassle.

This may or may not help but if your a veteran, you can get the VA to do the surgery for free.

Not a vet  Did find out that the referral was denied because the Dr put I wanted the VSG adb because they do not cover they denied the referral. After an hour of discussions with the PCP adn Health group people they will approve a referral to the same surgeon as long as its for RNY or LapBand. So Monday we will resubmit for RNY and then ask for the VSG or DS adn fight the insurance At least I amde some progress however small it was it is something

http://www.drjoya.com/internet.html just a thought....

Dex I am getting closer to that everyday. It just seems like I pay a ton for insurance and shouldn't have to deal with these issues.  I have a list of Drs that I can self pay if that the way I have to do it

also see if there's anything to pick up from - http://www.obesityhelp.com/forums/insurance/

a lot of info there and resources for getting approvals and winning appeals/Overcoming denials. (I have to use my “Reader/Lurker” when I’m surfing the MainBoard.  So Many have me ‘Blocked’ out there I can’t make heads or tails of the Board when logged in under my usual posting profile.) Best Wishes- Dx

 

Dx everytime I post of these threads I can hear in the back my head of head laughing your ass  off saying I TOLD YOU SO. I wish I could get to the appeals stage I still can't get a referral from the PCP to the surgeon. I spent over an hour in his office today talking with the Medical group only to find out hes out for 3 weeks. If I didn't have kids I would drive off a cliff its so frustrating. or at least really beat the hell out of someone

I am hoping for a two step DS because of my higher BMI. I would be happy with a DS. But am dead set against the RNY, I will self pay before i get the RNY just because thats what my insurance will pay for. I did make some more headway today. The HMO had the Dr they want to send me to call em adn do a phone interview to see if they could talk me into coming to see them for the RNY, as they ONLY do the RNY or LapBand. After about 20 minutes they agreed I should go the the other Dr who offers 4 surgical options because I was so set against RNY. Hopefully they will actually help sway the HMO to give me the referral to USC. Oddly enough the Dr they had call me trained under the Dr I want to go see. Int he end she agreed with me, we will see what happen next. Everyday I closer and closer to self paying or just waiting until FEB and switching over the a PPO plan.