Post by songbird177 on Jan 9, 2012 21:38:57 GMT -5
Ops posted this in the wrong place, so here it is lol.Sorry if it seems I am posting alot about insurance, it just seems like every day there is a new problem with my insurance and trying to get a referral for a surgeon and not sure where to get more info.
Anyhow, if you are just tuning in, the insurance that I have is medi-cal (medicaid for CA) and anthem. It isn't straight medi-cal. I am told medi-cal is my primary insurance, though, the doctors I see and choose from I change through the anthem part of it. I don't know if any of that makes sense, but I'm hoping it does lol. Also, I have been trying to get surgery since 2008 but keep running into troubles. The first few years was mainly pcps saying how they would not refer me because I just need to diet and exercise and that I am young, etc. I finally got one to agree to refer me in 2011 but she left the practice.
So it seems as if my problem right now is the medical group keeps sending me to the only bariatric surgeon they have in the medical group. This surgeon does not do the surgery type that I want, the DS. I was told today that to go outside of the medical group, I have to have my pcp do something called "access to care." Does anyone know what this is? I was told you can do this if there is no specialist in the medical group or area and they could approve it on a one time basis to go elsewhere. So I told this to my pcp's office today and I am not sure if they understood what I was saying or not but at the end she said she would do it for me, but I think she may just be resubmitting the referral for a bariatric surgeon. I feel like I am getting nowhere with this doctor's office and I want to be more informed on what I need to do.
Does anyone know if this is the right way to do it? I didn't get the chance to say for them to say it is for a specific bariatric surgery before we hung up but they will probably deny it anyways right? And I can appeal? Am I even going about this the right way?
Anyhow, if you are just tuning in, the insurance that I have is medi-cal (medicaid for CA) and anthem. It isn't straight medi-cal. I am told medi-cal is my primary insurance, though, the doctors I see and choose from I change through the anthem part of it. I don't know if any of that makes sense, but I'm hoping it does lol. Also, I have been trying to get surgery since 2008 but keep running into troubles. The first few years was mainly pcps saying how they would not refer me because I just need to diet and exercise and that I am young, etc. I finally got one to agree to refer me in 2011 but she left the practice.
So it seems as if my problem right now is the medical group keeps sending me to the only bariatric surgeon they have in the medical group. This surgeon does not do the surgery type that I want, the DS. I was told today that to go outside of the medical group, I have to have my pcp do something called "access to care." Does anyone know what this is? I was told you can do this if there is no specialist in the medical group or area and they could approve it on a one time basis to go elsewhere. So I told this to my pcp's office today and I am not sure if they understood what I was saying or not but at the end she said she would do it for me, but I think she may just be resubmitting the referral for a bariatric surgeon. I feel like I am getting nowhere with this doctor's office and I want to be more informed on what I need to do.
Does anyone know if this is the right way to do it? I didn't get the chance to say for them to say it is for a specific bariatric surgery before we hung up but they will probably deny it anyways right? And I can appeal? Am I even going about this the right way?
