HealthNet + Sharp Rees-Stealy Medical Group - ThinnerTimes

hxquero · 05-27-2006, 10:14 PM

I have been battling weight since I was 8 months old...my immunization record advised my mother to palce me on a diet at that time! I have tired everything...from slim fast to amphetamines to Meridia! I am so frustrated...I have tried to do everything I can on my own...but have not been successful! I have already attended 2 seminars on WLS @ Sharp. I have also done my research through personal acquaintances. After much consideration and thought, I have decided that this is definitely something I need to do for myself!! So I have an appointmen with Dr. Sartor (my PCP) to see if he will refer me to Dr. Jabro for a weight evaluation on Tuesday 05/30/06...I was told this had to be my first step. My only fear is that HealthNet won't approve me...has anyone had successful and fairly easy approvals from HealthNet with Sharp Reese-Stealy medical group??

ers2433 · 05-27-2006, 10:27 PM

Hi, I can't help you with any info on Healthnet but just wanted to welcome you to the forum.

You found a great place to get lots of information and great support.

Good luck with your process through the "insurance" journey

Hopefully it will all go smooth for you, I do know there are appeal process if they don't and have read of many people winning there appeals .

Keep us posted on your progress

Gina in NY · 05-28-2006, 06:23 AM

Welcome to the forum. When I had health net, they were pretty good. Do you have a contract you can look at? When I decided to start this process, I just called my insurance company and asked if they covered CPT code: 43846 (that is the gastric bypass number) and what their requirements are. I would think though, that Dr. Callery's office knows already. Ask them too.

No matter what happens - don't give up! FIGHT FIGHT FIGHT!

Good Luck!

(by the way, when you write in all capitals, it means you're shouting - maybe you wanted to shout all that, just wanted to be sure)

HAMPTON5555 · 05-28-2006, 07:28 AM

I have Health Net and Sharp Rees Staley.

One you get approved for the consult I was told that the rest is pretty much approved also.

I worked with my doctors for 5 years before I asked for the consult, but once I got it, I saw Dr. Callery and with in days I was aproved for surgery.

I hope all works well for you!

Rain

Bypassingme619 · 05-28-2006, 07:32 AM

I am not sure about Healthnet either but I would like to Welcome you aboard. I would also like to suggest calling your insurance company and seeing what the requirements are for approval. Like most insurance companies these days they want documentation of previous weight loss attempts or maybe even a thumbsup from your primary doctor. My advice go in there educated about the facts and be prepared for whatever they(insurance company) may throw your way. Keep us posted on your progress.

WantToRun · 05-28-2006, 09:57 AM

Yay lol! Someone i can help!
I have health Net HMO/Sharp reese. I have been waiting for someone i could give advice to

Health Net is GREAT. You have to have your pcp give you a referal for Dr Jabro. Dr Jabro's office will call you to set up and appt. The first one they set up for me was about 3 months out. If they do that have your pcp call them and they will move it up. I ended up having mine moved up to about 2 1/2 weeks out

Dr Jabros office will say he wants you to bring documented weight loss attempts, but he doesnt count WW, JC or anything like that ... he only "counts" medically document proof. If you dont have it he is going to try to put you into THEIR "medically supervised" diet program. Here is the thing though. #1- Health net doesnt require the med diet and #2- Neither Dr Callery nor Dr Mueller(the 2 surgeons he would refer you to) require it either. He is going to try to stall you and tell you they(the surgeons) wont take you and that he doesnt feel your ready yadda yadda but if you put your foot down and tell him you are and they you will continue to appeal it until you get it he will cave. Honestly i left his office crying becuase he told me he would put it through to the "department that ultimately decides" but that he didnt believe i needed it "just yet". A week later in the mail i get the referal to Dr Mueller

I had only met Dr Callery before getting the referal but i called and went to Dr Muellers seminar and i found that i REALLY liked Dr Mueller. Hes awsome. Once you get the referal from Dr Jabro's office its all easy from there. Stay in contact with Chanelle (if you go with Dr Mueller) and she will totally take care of you and zip you through the process. Health Net will cover it as long as Sharp reese approves it .... the "approval" is what Dr Jabro's "department that ultimately decides" does when they send you the referal.... so once you get the referal... youre in

If you have any other questions for me pm me anytime!!

hxquero · 05-28-2006, 06:46 PM

Thank you very much for the advise. I don't think I'll have problems getting the referral to see Dr. Jabro...Dr. Sartor is pretty cool. Thanks for the heads up on Dr. Jabro...now I know what I will be up against. Do you think he will accept a note from a Dr. in Mexico...I mean in regards to a medically supervised diet history?

hxquero · 05-28-2006, 06:49 PM

Thanks for the warm fuzzy welcomed feeling!

I no longer feel alone! I look forward to reading all your advise and suggestions! I was so amazed to read how successful this surgery really is...this forum helped me realize that I too should have it done...not just for the lbs...but for the energy, happiness, and health! You are great inspirations...keep up the good work!!

WantToRun · 05-28-2006, 09:49 PM

Thats a great question! I honestly have no idea. A mexican doctor is of course still a doctor but my guess is that he will still try to stall you *shrug* i figure he does with everyone. I suppose thats why they call him the "gatekeeper"