Question:
Denied Referral

My PCP tried to give me a referral to another bariatric center but was told I was denied I went to see my PCP today and asked if she could give me a referral to a center that is contracted through Kaiser. She later on called me to tell me that she couldn't. I called member services as to see why and they told me that they did not deem it "medically necessary" for me to go to a center in San Diego rather than the one closest to me. I have tried to explain that I do not feel comfortable with the one in San Fran. Should I just try to stick it out with kaiser or switch to blue cross while it is open enrollment? Please help! God Bless    — AliciasMommy (posted on October 6, 2001)

October 6, 2001
Switch insurances and get back your choice. If the HMO is rough NOW, wait til you have a problem post-op or need labs. This can be very dofficult with HMO. The only insurance I can find that covers WLS that is available to a small company like me is HMO. NO WAY. I will wait til we qualify for a better plan.
   — vitalady

October 6, 2001
Hey Tiara. Please e-mail me with the details of your struggle with Kaiser. I may be able to help (read my profile for more details). Kaiser can be tough, but they WILL cover the surgery if you meet their guidelines. They only contract out to one place in San Diego, but they contract out to a couple in LA, and SF has their own WLS surgeon with a LOOOONG wait list. You may need to find another PCP if yours is refusing to refer you again. She may have sent the referral with some info missing, thus resulting in a denial. E-mail me at [email protected].
   — careywatkins

October 6, 2001
Honey SWITCH TO BLUE CROSS NOW! Kaiser is a nightmare. Call the center in San Diego and find out the billing code for WLS. Then call Blue Cross and see what the criteria are for coverage. See if your company has a traditional plan (where a PCP is not required). This is what I had (Highmark BCBS/Anthem) and I didn't need a referral, could choose whatever surgeon I wanted and everything is covered. Good luck and God Bless!
   — Kimberly L.