Question:
Have anyone had the DS procedure with HealthNet
Hi everyone, I want to know if Health Net Ins. put you threw hoops to get approved for surgery. I have health net and want to be prepared if I have to fight. — TCP1918 B. (posted on March 11, 2002)
March 11, 2002
My husband and I both had the DS with HealthNet with no problems getting
approval (his was in June of 2001, mine was in June of 2000). In talking
to people currently,however, HealthNet is taking some pretty big strides
towards not approving the surgery - claiming that it is now an
investigative or experimental procedure and referring people for the RNY
instead. I would expect to have a fight on that issue. -Kate-
— kateseidel
March 11, 2002
I have Health Net of Oregon ~ feel free to read my bio. for more details or
email me to see if I can help (if needed). I have gone head to head with
them for well over a year now and I've recently "lost" (for lack
of better terminology).
I even hired a top attorney in the state of Oregon for fighting the
exclusion they've put into place and was told that there is a "marissa
(?sp?) law" that would take the appeal into a federal case. He stated
that nothing is "air tight" as others (obesitylaw.com) has stated
for other insurances ~ he just stated that it would cost thousands and
thousands of dollars to fight it. He said it still wasn't a sure win. I
believe in the future, that insurance companies will be educated enough to
learn the benefits of this surgery - not only for the patient but for
themselves in preventing other major illness to occur from being morbidly
or super obese.
I have vowed to fight, scream, yell, voice my opinion in every direction if
God allows me to come through this surgery in good health and with more
energy.
Like I say in my profile ~ they've jacked with the wrong big mouth. :)
Good luck in your plight !
— Lisa J.
March 11, 2002
Hi Tammie ~ I have HealthNet HMO through my employer. I was approved for
my RNY within a few hours of when my doctors office called for
authorization. I changed doctors and again received almost immediate
approval with my new doctor about two months later. Although I do not have
any co-morbs, my BMI was just shy of 5O. I really don't even know if
HealthNet asked for this info, but I have a history of medically supervised
weight loss plans and since my first surgeon required that I see a number
of specialists, I had letters from them saying I would be an ideal
candidate for this type of surgery. Good Luck to you!
— PaulaM
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