Cynthia

Ok so here I go with my venting...l saw my pcp on monday and was so excited when she agreed with WLS and was on board with me. She said that she will submit the referral to the Bariatric Surgeon and I should have it in 5-10 days. I was on cloud nine. So happy I cried all the way home from the dr's appt. Well I have Health Net insurance and my medical group is Vantage. I called health net to get surgeons in my area so that I could do some research and they said that they cover the hospital stay but my medical group covers the surgery. They gave me the number to call them for more info. So I called...and waited...and waited...and was on hold for 30 mins before I got a live person and then had to be put back on hold and transfered to someone else..ugh Ok so I get a LIVE person on the phone and ask my questions..1st(Requirements for WLS) 2nd(Doctors who preform the surgery in my medical group..Well she said that the requirements they have differ from patient to patient. I asked if they had anything in writing or on the internet I could look at as far as the surgery goes..She said NO. I then asked what are some requirements for differant people. She said some have to have 6 month doctor supervised diet, and some don't. I then asked what are the factors that determin that..She said they decide that and can give me no further info...So Unhelpful. Then I asked about surgeons in my area and she said that in my medical group there is none, but Vantage does cover WLS. I am so confused and frustrated. Anyone else have or had this problem??

Sherry_Lynn

Wow.............how confusing! I would call them back and ask to speak to a supervisor. If that doesn't work, ask for a Case Manager to be assigned to you. I mean, how on earth are you supposed to get approved with those vague guidelines! Be persistant! Good luck!

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Sherry Lynn

Proud Mom of two Saint Bernard Puppies, George & Gracie

Lap RNY





Highest/Day of Surgery/Current/Goal
336/303/229/180

Cynthia

Thank You. I just called and they had to take my name and number and have a supervisor call me back. I will be calling every day until I get a direct answer..lol I also have a call into my PCP office to see if they can call too and get some info. I will keep you posted. Have a FABULOUS day.

poet_kelly

I was also going to suggest speaking to a supervisor. It doesn't make sense that they can't tell you the requirements. I don't believe they make them up as they go and that they are different for each patient. That makes no sense!

If there are no surgeons in your area that are covered on the plan, then you should ask for them to pay for someone out of network. If WLS is covered, they should agree to that. But you may have to argue with them about it.

Kelly

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RNY 11/4/08

surgery/current/goal
270/147/130