Update

hey all , I know you all are sooo interested , hahahh but owell... SO......Dr. Asbum DOES take HMO and I will be scheduling my appt. soon as they call back..Now , if , Dr. A decides I am a good candidate for Ds and would like to do it , either I can go the harder route , ask my pcp to request another authorization, now that I have a reccomendation from a Doc who does Ds and ask that I just get it from him , since I'd already seen him and blah blah blah..WHich they might just decide to deny again , then I would have to appeal all over again.. Or I can just switch medical groups to Dr. asbums, and change my PCP and all of that ,have a new consult with them, have him reffer / reccomend to dr. A , blahah, which will probably go faster I am sure, IF I can get my new PCP will reffer..(hoping that he/she is pro DS!!) sooooooooooooooo lovlies, what would you do? input ? thanks xoxox sara bears

See? The response I got five months ago from the Mt. Diablo program where Dr. Asbun is located is already out of date -- good to know!!! Always, always, always investigate everything for yourself. On wether to change to Asbun's medical group: first have your consult with him to see if you like him, how many DSs he's done ... I can't find figures on that, and the stats on the OH.com site show him as having done mostly RNYs. Find out his mortality rates, etc. If you like him and his background and qualifications, then move forward. Health Net referred you to Asbunbecause DS services aren't offered within your medical group. Asbun apparently takes Health Net HMO, so that's good. A red tape nightmare may ensure when Asbun files for authorization to do the DS -- in my case, neither my medical group nor Health Net wanted to deal with my out-of-network surgeon's request, each thinking that the other should deal with it first. ARGH. That was extremely frustrating. You may save yourself some aggravation if you're willing to switch medical groups to one that includes Asbun. Call Health Net first and find out when/how to do that: it doesn't actually take that long, but for me it was going to be a couple of months before I could get the ball rolling again, and I preferred not to wait. Of course, I'm ending up waiting ANYWAY, but whatever ... However, after that there's another battle, which becomes whether Health Net will deem the DS "medically necessary" and appropriate for someone of your BMI (if it's 50 or greater, you'll have an easier time; if it's under 50, even with comorbidities, you'll want to make a case for the DS being apprropriate for morbidly as well as supermorbidly obese people, as Health Net recommends either the RNY or the lap-band otherwise). Health Net will not necessarily take your surgeon's or your PCP's word for it without documentation that you meet all its criteria for the DS, so make sure you/your PCP/your surgeon address *all* the issues I outlined in a post to you yesterday. ALL of 'em. Cover all the bases, make sure your surgeon and doctor address all the issues ... And then ... WOOHOOOOOOO! P.S. I don't actually do IM very well ... I'm way too slow at it. But you're welcome to email me anytime at [email protected]. Alison

Once approved, you can change doctors, if the doctor accepts the insurance ,is net or what ever, not the insurance companys choice. i would get a referal to the ds surgeon, that will be required , and why should you pay for it, I had two surgical consultations in the same group practice two days apart. paid. then the doctor can send your authorizaion letter along with his updated justification for the ds, and you should be good to go.

Hey Sara Beara- I would hope that Dr. Asbum's office will be able to refer you to a DS friendly doc that is within your new group. If not, I guess you will just have to see. Either way I think switching medical groups is the way to go to avoid all of your above mentioned hassles. Besides, I'm sure if you ask the receptionist while making your appointment, she would tell you whether or not the doc is DS or WLS friendly, if she knows. You can always ask to speak to his nurse too. Good luck Sweetie! Hugs, Katie