Tenncare Troubles--PLEASE HELP.

Well I had an appointment last monday at my pcp's office. All went well with her, she was supportive. The only thing is that when she sent in the referral for just a consult with Dr. Madan it was denied. It was just a referral to see what the surgeon had to say. It's not like I had sent in an approval letter for surgery. I don't know what to do. To be so early in the game and to be outright denied for just a consult with a surgeon..it's ridiculous. I'm at a loss. I am calling tenncare tomorrow and going to ask them outright what the steps are for this. I talked to the woman who deals with tenncare at my doc's office and she said that Tenncare won't pay for bariatric surgery and the only thing they will do is to put me in Weigh****chers. Sigh...I've done weigh****chers..but it was a long time ago and I doubt they have records back that far (I was like 12 years old at the time). I am so disappointed that I could cry. If anyone has ever dealt with tenncare or seen Dr. Madan and has any ideas on this please, please help me. Thank you. I'm thinking about just scheduling a consult myself and paying for that appointment and maybe they can help me from there?? I just don't know what to do.... Jess

Jessica, I to have TNCare/Medicade. I don't know if this is what you have but I had no problem at all. I just called TNCare & they set my appt. w/ my surgeon. I to didn't get the surgeon I really wanted, but the one I had was wonderful.It is true that they have started the Weigh****chers thing, but I would think that they may just want you to try it at least. I hope you won't lose your drive, it takes a lot of pushing sometimes to get what you need. Keep on trying & you will get it. Best of luck to you. Sara.

I have tenncare/omnicare. So I should just call them and ask them to set me up with a surgeon? I don't mind if I have to go to WW, that's fine. Should I ask for a caseworker? And should I ask them about all the steps that I need to do in order to be considered for the surgery? (Sorry I'm Flying Blind here) If i don't see Madan that's fine..maybe I have to go with someone IN Network. It just seems silly that they would deny a refferal just to go see a surgeon to discuss my surgery options..Thanks Jess

Hi Jessica, on the back of your TNCare card is a customer number, call that number and ask for a case manager. They will work for you to help you get approved and what you will need to do. They will contact you every month up to a year to see if you need anything or how they can help. After a year if you have had your surgery, they will drop you at that time. If for any reason you haven't had surgery yet, they will keep your file open. Your surgeon may not be in your network, but TnCare does pay for gastric bypass once you qualify. The letter of referral that your PCP sent must state it's medically necessary. Otherwise, it's automatically denied. I wish you much success in your new journey to a better life. Kathy

Hello Jessica Johnson, I too had some trouble with TennCare(blue Care/ blue Sheild medcaide of Tenn) They will pay for it. It could be that the doctor you wanted was not on their list. Try calling around in the phone book for doctors at hositpals that will take your insurance. If some do not ask them if they know of a doctor that will. You might have to drive out of you county to see this doctor but it is worth it. I drive from knoxville to Johson City for my doctor. Plus call the number on the back of your card and ask them if they have a list of doctors who does the bariatric surgery. They will give you several numbers or you can have the numbers faxed to you too. You will asked your Pcp office to set up the appointment with the doctor. In most cases like mine I did not need a referral from my pcp. ALL I had to do was make the appointment and comfirm that my insurance will and have paid for it. When you set up your appointment your WLS doctor will send you a packet for you to read and fill out. Call everyone including your WLS Doctor to see if everything is covered by your insurance. It is always nice to make sure you have everything. I hope this has helped you. Please do not let the little objects stand in your way. I was pushed around for three years until I came to this website. I had some good poeple and friends who gave me sound advice on how to handle my insurance and my doctor. And here I stand at the end of my 6 month diet and about to go to my second appointmet with my WLS and then I will wait to see if I am approved or rejected. I will tell you this I will fight and keep on trying. Never let some one treat you badly and if you get one rejection then turn around and try and try until you open those doors to approval. All through your struggle know this you have your friends here to help you with your requirement troubles and your personal troubles and questions.Do not wait ask away we are always here for you and anyone who will need us. Remenber we are all friends in this struggle against obesity. And we are all wanting a healthier and happier life. We will not stop until all obese poeple are happy with themselves. Your friend, Tina