Post by songbird177 on Dec 27, 2011 19:47:26 GMT -5
Well I had previously done a post on when to call after they sent in a referral and someone told me to call and checkup on it now and I am so glad I did (and a little down with what they told me but hey it's not over yet!).
So basically having this poor customer service guy with anthem find out some info for me. I say poor guy because he has been working hours trying to call places for me and has to do more tomorrow lol. Anyways, we found out that they approved me again to see the surgeon I previously had been seeing (who does NOT perform the DS and who I didn't like very well) even though the drs office put a diff dr name down. The man on the phone explained why they did that and it is because of the medical group I am in with anthem. Apparently, you are part of a certain medical group who has specialists and drs associated within them. And the one I am in only has 1 bariatric surgeon, which is the one I have already seen. Also, they are not contracted with the only hospital he performs the surgery in so it isn't an option anyways. He said I would have to change medical groups and pcps. I don't mind changing pcps, didn't like mine anyways. Just haven't changed it because it looks better if they are familiar with your diet efforts for the letter they will have to write later to the insurance and also I was told I would have to redo the 6 month diet. However, I found out, thanks to all of the wonderful people here, that I can appeal that so that is helping my anxiety a little bit.
The man is going to call the dr I found tomorrow to see if they accept the medical group. When I looked before online at the anthem site, I looked up my medical group it didn't list this dr that I found so I am a little worried about that. I should also mention for those who don't know that the only dr I found is in los angeles and I am in sacramento. I am hoping that the only medical groups they accept arent for only people who live in los angeles. Also, I was supposed to attend a seminar with this doctor next week but now I am not sure I should even do that.
I know you can pay out of pocket for the consult and get the surgeon to write a letter stating the ds is the best for you so this may be my only option if the insurance says no tomorrow, though I have heard that this dr I am going to isnt really pro DS so it may be difficult.
I've been trying to get some kind of WLS since 2008 and it felt so close this time, finally finding a dr to say yes, but then now it feels like more and more dead ends. I am trying not to get down about this but it is really hard. But I know the fight isn't over yet and I must keep trying. Thank you for listening and all your help so far.
So basically having this poor customer service guy with anthem find out some info for me. I say poor guy because he has been working hours trying to call places for me and has to do more tomorrow lol. Anyways, we found out that they approved me again to see the surgeon I previously had been seeing (who does NOT perform the DS and who I didn't like very well) even though the drs office put a diff dr name down. The man on the phone explained why they did that and it is because of the medical group I am in with anthem. Apparently, you are part of a certain medical group who has specialists and drs associated within them. And the one I am in only has 1 bariatric surgeon, which is the one I have already seen. Also, they are not contracted with the only hospital he performs the surgery in so it isn't an option anyways. He said I would have to change medical groups and pcps. I don't mind changing pcps, didn't like mine anyways. Just haven't changed it because it looks better if they are familiar with your diet efforts for the letter they will have to write later to the insurance and also I was told I would have to redo the 6 month diet. However, I found out, thanks to all of the wonderful people here, that I can appeal that so that is helping my anxiety a little bit.
The man is going to call the dr I found tomorrow to see if they accept the medical group. When I looked before online at the anthem site, I looked up my medical group it didn't list this dr that I found so I am a little worried about that. I should also mention for those who don't know that the only dr I found is in los angeles and I am in sacramento. I am hoping that the only medical groups they accept arent for only people who live in los angeles. Also, I was supposed to attend a seminar with this doctor next week but now I am not sure I should even do that.
I know you can pay out of pocket for the consult and get the surgeon to write a letter stating the ds is the best for you so this may be my only option if the insurance says no tomorrow, though I have heard that this dr I am going to isnt really pro DS so it may be difficult.
I've been trying to get some kind of WLS since 2008 and it felt so close this time, finally finding a dr to say yes, but then now it feels like more and more dead ends. I am trying not to get down about this but it is really hard. But I know the fight isn't over yet and I must keep trying. Thank you for listening and all your help so far.
