Medi-cal(medicaid)/anthem question

[songbird177]

Also posted this in the insurance part but in case no one reads that section, here it is:

So I was trying to get the DS and the only dr in california is in los angeles that takes my insurance and I am located in sacramento, some 8+ hour drive away. So I asked my pcp if they could refer me to him and they don' t think my insurance will let me because I guess the medical group portion of anthem that I am in is only good for doctors in sacramento. They are going to submit it anyways and see what happens. But the thing is there isn't any bariatric surgeons in sacramento that take my insurance. If the insurance denies me like the pcp office thinks they will does this mean I am out of luck to get the surgery? Or can I have my pcp write a letter to the insurance, or even myself, stating why I need the DS, etc? Thanks in advance!

[Deleted]

If you get denied, you will need to SELF-PAY for a consult with the surgeon who takes your insurance (I hope it is Keshishian). Then appeal, with his Letter of Medical Necessity (LOMN) supporting why the DS is best for your medical condition. If they deny again, you appeal to the DMHC - if that is the route of appeal for your plan, or wherever Medi-cal requires that you appeal for external medical review. (There may be second level appeal required with the insurance company - you need to find out what the requirements are.)

[songbird177]

Thank you, you have given me hope! Happy Holidays!

(And it is with Crookes, Dr K doesn't accept medi-cal anymore, nor does Rabkin :/)