Need Help Getting Started

Hello to all, I have just joined this site and I'm hoping I will finally find the help I need to have my surgery. I have been at this for around 6 years now with no luck. I need a Primary Dr. who will approve me for surgery, I live in the High Desert, Victorville CA and have Health Net Insurance. I was going through the steps they said necessary to have the surgery in 2007 when I had very bad female problems and had to put all on hold. When I returned last year to my Primary Dr. she told me I would have to start the games all over again! I would like to know if anyone can please help me.
Since I have joined this site I can't believe the information flowing in but I am at a loss as to where to begin. I am receiving a lot of info about MX surgeon's that seems very scary to me, also I don't think our insurance would cover this?
Thanks so much to anyone who can help.

If yo hae Health Net and its HMO you will need your medical group to send you to the dr they are contacted with.  If its HMO find out who the insurance co is contracted with.
Liz

Thank you so much for your help, I will look into it... I am hoping to find another Dr. who will help me more that is here in the High Desert. If anyone knows of a good Primary I would love to have a name.

Thanks again, by the way you look great! & your daughter is beautiful!
Ammisha

Make sure you research ALL of your surgical options.  In particular, Health Net will cover the DS -- even if your BMI is less than 50 (their policy says that it is limited to BMI >50).  You will have to appeal, but the CA Dept. of Managed Health Care will FORCE them to cover it.

Your doctors are SERVICE providers.  If you don't like your PCP, find another one.  If you can't get a referral, then file a grievance with the DMHC -- that is a constructive denial.

If your insurance requires you to do a preliminary diet, you can file a grievance with the DMHC and they will make HN waive the requirement.

Unless you have an exclusion in your policy, you do not need to consider going to MX -- HN can be made to pay.

You can do this.  You are VERY fortunate to live in CA, where the DMHC can help you in many ways.

Thank you very much for the information you have been very helpful... can't wait to get started.

Hello Diana,

You were kind enough to answer questions before.. I am on the way to my Dr. this morning and was talking to my friend Terry who said you had helped her out with having her surgery "Sleeve" Partially Overturn. She suggested that I ask the Dr. today for a Ref. for wt. loss surgery and to tell her I meet the criteria and if she denies me to inform her that I will be going to Health Net for an Appeal. She also said she thought you might have Health Net yourself or have dealt with them before and might be able to help me... Thank you so much for any help you can give.

Sincerely,
Marcia/Ammisha

I did have HN, but not when I had my DS in 2003.

Hi Diana,
 
I was just reading back over the information you had given me before which I believe has answered my questions I had for my Dr. apt...  
It is so wonderful to have friends like Terry and so much help from this site...
i am sure I will have many more question and requests in the future, thank you so much for being here for me/us.

Ammisha

Hello Diana,

DianaCox's reply was:
I did have HN, but not when I had my DS in 2003

Thank you for getting back with me.

I went to my Dr. apt. asked her again if she would give me a referral for surgery she said I had to start all over again with weigh in's.... They also told me they did not have records of all my weigh in's from 05 and that I had gone to the nutritionist. Does this now mean it is their word against mine? Do you have any idea  what and where I should go from here.... I am so frustrated with the games they are playing. Do I need to go to HN and talk to them? I would appriciate any direction you could give me.

Sincerely,
Ammisha

I'm a little confused here -- I can understand that you have to prove a 5 year history of being MO, but what weigh-ins?  You need to have a six month diet, with monthly weigh-ins?  Because THAT can be overcome -- you just call the DMHC and file a grievance for them trying a mandated diet: http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf