Hi All! New to Boards. HMO Question. (Community Premier Plus)
I have Medicaid, with Community Premier Plus as my HMO. I would like to know if there is anyone here with same, and if so, did you have to wait longer than expected for approval on anything, or did you have a problem even getting an approval for anything. I was reading up on HMO guidelines, and unless I read wrong, decisions on medical procedures are made in 3 days, so then why everytime I need approval for something I'm told to wait like 3 weeks? I don't get it.
Hugs - Robin
wow, i had the same exact thing medicaid with community premier plus, i had some problems with cpp because there not accepted in hospitals i wanted to go to. like were do you want to go see a surgeon at, well when i went to mount sinai the doctor accepts my medicaid but not the plan, as well as new york presbyterian, and cornell.
so what i ended up doing was switching plans. now another problem i'm having is with medicaid, together with a plan, coz now it's either medicaid alone or plan. so if you find anything, please tell me because you and i are in the same perdicament.
and welcome.
bye.
Hi Glenys. Thank you for responding. I actually have a surgeon and hospital that is accepting my plan. My concern is over the time it has been taking to get an endoscopy done. I actually spoke with a CPP rep. today and they told me that it does only take 3 days for them to make a decision on surgeries and certain procedures. The delay is on behalf of the hospital who most likely is dealing with submitting the paperwork of many other patients so that slows things down.
Now as far as what you are going through, you should have been able to find a place when you had CPP. I know it's frustrating because it took me awhile and many phone calls to places that I searched for on my own just to find a psychologist that took CPP and was willing to see me immediately, other places had waiting lists. Thats what sucks about HMO's. It use to be easier with straight medicaid. North General Hopsital is where I have been going because they take CPP with my medicaid, and the surgeon who also takes it is Dr. Howard Beaton, who is chief of surgery there and also works at Mt. Sinai.
I don't know why Presbyterian told you they don't take CPP because they told me they could, and I thought to call them first because they are one of the few Hospitals that are affiliated with CPP, but I would have to prove so much to them medically, and they had an 8 month waiting list of people awaiting their submission for approval. Presbyterian has a good reputation so I can see why many want to go there, but their waiting list for this surgery, and other procedures, is just more than I was willing to wait.
What plan do you have now? I can look into it for you and see what I can find, if you want. Otherwise, you may consider going back to CPP and going to North General which is on Madison Avenue in Harlem, but it's just a suggestion. I never switched plans before so I don't know if thats a lot of trouble, and I would want you to find a place and surgeon that you fealt confident with.
Also, just to let you know, Dr. Beaton is only surgeon there who does WLS so if you ever decide on North General, the first appointment they give you may not be until like a month later, but once you are in, they get you started on things right away. Hope any of this helps. If you have any questions, feel free to ask. I'm new to this whole thing myself, but I'll do my best to help. Take care. 
Liz
Liz 
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