Re: DS Approval Problem/margy

[Guest guest]

margy: i have private insurance thru my dh's employer frito-lay.

they have united healthcare ppo options to administer their plan.

and health international is the company that does extra

considerations for normally non-covered requests. i have been

approved out of network for my surgery. i live in st. louis and am

going to ocean springs, ms to dr. booth/warden/kim for the surgery.

good luck in getting your approval.

mary y st. louis

itchin to be switchin

> I'm hoping someone can give me some assistance. My PCP is all for

the

> DS surgery, and submitted the request to my insurance which is

> Lifeguard HMO here in Northern California. I expected them to deny

it

> and today I received the denial. They say they will not cover it

> because the DS doctor is outside of Lifeguard's network and that I

> need to see an in network surgeon. But of course, there aren't any

in

> network surgeons who do DS.

>

> What should my next step be? Should I just go ahead and appeal? I

> suspect that the next denial would be because they think the DS is

> the same as RNY and I should go to one of their RNY doctors.

> Or...should I try to figure out which insurance companies have paid

> for DS with the DS Dr I want and hope one of them is one I can

switch

> to next year? I do hate the thought of waiting that long.

>

> Has anyone had any luck getting insurance approval for DS outside

of

> their network?

>

> Sigh...

>

> Margy