Need Help Getting Started

I am sorry I have not made myself clear... In 05 I was going through the 6 month weigh In's when I became ill and had to stop. I have recently gone back to the Dr. and asked if she would give me a referral now that I am better but she said I had to start all over again and that they had no history of my weigh in's from 05. So no need to even contact Health Net...
Thank you for your help... I will now contact DMHC,

You may also considering finding a surgeon and then asking that surgeon who is a good PCP to go to who will be supportive.

OK, Thanx so much... Everyone on this site is just great... I am getting more help/infor here in three days than I have had in 6 years...  

Thank you all, Ammisha

HI, I had my surgery done un Tijuana, Mexico (not scary at all) with Dr. Jaime Ponce de Leon, it went great, it was done in a nice hospital, professional staff, reasonable price ($6,400 for the lap band procedure) they handled all the logistics. You can google him and check their website.

I think what you should do is go back to your PCP and bring in the peer review from the CA DMHC.
Bring your Health Plan booklet that shows your criteria for WLS. Tell her that HN may require you to do the 6 month diet but it goes against the standard of care in the US. If you meet NIH criteria for WLS then she should refer you, you shouldn't be made to jump through any hoops and prove you can and will lose weight with dieting. Beg her to please put in for the referral NOW and that you know it will be denied; but that you need that denial to appeal directly to HN. If she refuses I think you should do is just file a grievance with Health Net against your PCP for not referring you for the consult. Like Diana said what she is doing is essentially giving you a constructive denial.

Your story sounds very similar to mine. I too have Health Net and had the run around for the longest time before I finally got approval for my DS. I lived in the high desert too and the medical care up there is less than stellar. The doctors will not refer for anything, you need to put your foot down and demand the care you desire. If your PCP gets mad you filed a grievance against her, so what, as long as you get your referral and ultimately your surgery that's all that matters. You need to be your own advocate and stand up for yourself.

Here is a similar thread from the main board. Hope it helps and best of luck to you. CaliMom
http://www.obesityhelp.com/forums/amos/3866637/Denied-a-refe rral-for-not-having-6-mo-phys-doc-diet/#31043820