WTF??!!! I hate Healthnet NY right now.

So this is the deal.  My surgery would be approved, but my surgeon isn't on the accepted providers list so the insurance company cancelled my approval request.  What kind of SH%T is that?  The only reason I even found out is because I had the dr's office call the insurance company.  If they hadn't called we wouldn't have even known because the office wasn't notified.  So now the surgeon has to write a letter and there has been an appeal entered.  January 7th looks real iffy.  I guess it is just some more wait and see.  ARGGHHHH!!!!!!!!!!

Sorry your having such issues, I have Healthnet and they were a dream to work with but I also was sure the doctors I saw were approved by Healthnet before I met them. Perhaps it's best to find one that is approved rather than use one who isn't there are some good doctors who are approved.

I thought he was approved with them.  He had several patients that were Healthnet and extensive experience working with them.  I am not sure where the disconnect occurred but it did.  If I can find another surgeon I feel as comfortable with I will switch.

Sorry to here of your news... that really is a dissapointment!  I know what its like to have delays one after another (went through it years ago when getting ready to have RNY) This time around my surgeon wasn't in our preferred plan either (United Health Net) but they said they would pay 80% and he agreed to take what the insurance paid him.  He submitted his bill and they only paid him a small fraction of the bill.  Now he is having to appeal it and we are out of the whole loop.  I do feel for him and hope he at least gets 50%.  I am sure this is why Doctors don't want patients unless they are fully covered or insurances that pay the amounts they are supposed to pay.  At any rate... I'm sure this is something he does often and will get what he needs to get or he wouldn't have taken me on.   I am just sharing to tell you to hang in there.  If this doesn't work then you really should find another doc on your preferred list as you are considering.  OH and BTW  I feel a certain kindship to ya... lol the whole "loveinit" and luvinlittle" LOL Hang in there this too shall pass and it will be worth it! Sandra

Sandra.. Let me start by saying, I'm sooo sorry... But this too shall pass. Working for an insurance company, allow me to give you a little insight. It's quite possible that whom ever did the clinical review made a mistake, had a mis-spelling in the provider's name, the provider may have multiple records under different tax identification numbers (once as in-network, 1 as out of network)... it's quite possible that the provider may have been participating but may no longer be participating as of January 1st or... he may be participating with different associations (groups) within the insurance carrier.... Let me recommend this... Recheck your source that said he was participating.. If you show he is participating, re-contact the insurance carrier and give them your information.. Another option is to get your human resources department involved..

 

GOOD LUCK :)

Thanks for the advice.  I will look into it!