Insurance question - medi-cal/anthem

songbird177
on 12/22/11 2:38 pm - Carmichael, CA
DS on 12/03/12
So I was trying to get the DS and the only dr in california that takes my insurance is in los angeles and I am located in Sacramento, some 8+ hour drive away. So I asked my pcp today 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 surgery? Or can I have the pcp write a letter to the insurance, or even myself, stating why I need the DS, etc? Thanks in advance!
fullhousemom
on 12/22/11 10:14 pm
 Did you post this on the other forum?  When it comes to insurance issues, Diana is really the expert!  
songbird177
on 12/22/11 11:47 pm - Carmichael, CA
DS on 12/03/12
I posted everywhere I could lol
Tina.D
on 12/23/11 10:36 am - TX
I work in the insurance industry as do others here. You really need to first read your plan. Most likely if there is no one in your network they will grant the exception but you have to be your own advocate here.

The more you learn about your plan the better. If your PCP requests an out of network provider because of a specific clinical condition your insurance may first deny it but will approve upon appeal. What is your need for the DS? Also they may try to negotiate a one time contract with a local surgeon if you can convince the local surgeon to take your case.

Please contact your insurance company and ask to speak with a case manager, they will help you with the process as well.
 
  
   
  
        
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