Approval but have questions
I've had the lapband for 6 years. I never hit goal and am having quite a few issues. I found out today that UHC has approved my revision to the sleeve (with no issues - approval in about 2 weeks). I have a few concerns though:
1. I'm switching to Anthem EPN effective 1/1/10.
2. My dr of 6 years (Dr Cribbins) is not in network for Anthem for bariatric surgery. I don't have an out of network option
3. Surgery can't be scheduled until after 1/1. My insurance has a "Transition of Care" clause that will basically honor the UHC approval if I'm scheduled < the end of this year for a date early next year (within 90 days) and will cover it at the "in network" rate
4. My dr will make me pay like I'm out of network and cross their fingers that the insurance pays
5. Sleeve isn't covered by Anthem like it is UHC, although I might get past it with the transition of care clause, but I'm wondering if I should just try to get bypass approved since i know that Antham will pay for that
6. I need a good in network dr (D/FW TX metroplex) to possibly perform the surgery and definitely to provide aftercare next year. Antham can't provide me a list of approved bariatric in network providers
Can you say "STRESS"?
1. I'm switching to Anthem EPN effective 1/1/10.
2. My dr of 6 years (Dr Cribbins) is not in network for Anthem for bariatric surgery. I don't have an out of network option
3. Surgery can't be scheduled until after 1/1. My insurance has a "Transition of Care" clause that will basically honor the UHC approval if I'm scheduled < the end of this year for a date early next year (within 90 days) and will cover it at the "in network" rate
4. My dr will make me pay like I'm out of network and cross their fingers that the insurance pays
5. Sleeve isn't covered by Anthem like it is UHC, although I might get past it with the transition of care clause, but I'm wondering if I should just try to get bypass approved since i know that Antham will pay for that
6. I need a good in network dr (D/FW TX metroplex) to possibly perform the surgery and definitely to provide aftercare next year. Antham can't provide me a list of approved bariatric in network providers
Can you say "STRESS"?
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