Guest guest Posted June 27, 2001 Report Share Posted June 27, 2001 Does anyone have Health Net PPO insurance and were you approved ? Or do you know anyone who had it and got approval? A friend of mine is trying to get the ball rolling on this surgery and asked me to find out if anyone had Health Net and problems with approval...... Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2001 Report Share Posted June 28, 2001 Judie I have Healthnet PPO 10 and was approved for the DS with Dr Rabkin in 8 days! My surgery date is July 2. Kitri Olds Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2001 Report Share Posted June 28, 2001 Kitri.....thanks so much! Thats good news and this lady is going to be so happy to hear this......I will forward your email to her if thats ok with you..... Judie Re: Health Net > Judie > > I have Healthnet PPO 10 and was approved for the DS with Dr Rabkin in > 8 days! My surgery date is July 2. > > Kitri Olds > > > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2001 Report Share Posted June 28, 2001 Kitri......forgot to ask you if they required anything like diet plans etc? Did you have to go to your pcp to get a referral or did you just go to Rabkin for that? Judie Re: Health Net > Judie > > I have Healthnet PPO 10 and was approved for the DS with Dr Rabkin in > 8 days! My surgery date is July 2. > > Kitri Olds > > > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2001 Report Share Posted June 28, 2001 At the time of my surgery, I had Guardian/PHS POS, which is now Health Net and I was approved within a couple of days. Jane J. 230/190 Lap BPD/DS April 26, 2001 Dr. Ren NYU Medical Center, NYC Does anyone have Health Net PPO insurance and were you approved ? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2001 Report Share Posted June 28, 2001 Just because one persons HealthNet covered wls, doens't mean that another person's policy will. Each company (if it's thru an employer) purchases a contract that stipulates what is and isn't going to be covered in the policy/contract. So she is going to have to READ the policy prior to 'getting her hopes up', as her specific policy MAY have an exclusion Colleen - Iowa BPD/DS 1-15-01 Dr. Buchwald u of MN -7? haven't weighed in a while > Kitri......forgot to ask you if they required anything like diet plans etc? > Did you have to go to your pcp to get a referral or did you just go to > Rabkin for that? > > Judie > > > Re: Health Net > > > > Judie > > > > I have Healthnet PPO 10 and was approved for the DS with Dr Rabkin in > > 8 days! My surgery date is July 2. > > > > Kitri Olds > > > > > > > > > > ------------------------------------------------------------------ ---- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2001 Report Share Posted June 28, 2001 There's a double (possibly - according to the coverage secured by the employer) whammy giving HealthNet (or whoever) a way out on covering the DS. First, the policy may have an outright exclusion. This is purely according to what the employer decided when they made their agreement with the insurer or HMO. The insurer will deny based upon the exclusion of ALL WLS. Their second " out " is if the policy excludes experimental procedures. Thus an insurer can cover one WLS and deny another if they decide that one is " experimental " or, as is the case with HealthNet, " investigational. " HealthNet got hammered in the Fox v. HealthNet case when they claimed that a bone marrow transplant was " experimental. " The jury was left (by a very competent attorney) with the impression that " experiments " were done on rats. They came back with, I believe, somewhere over $80 million verdict. Perhaps this explains why Blue Cross is now using the term " investigational " in justifying their refusal to cover the DS. It may just be a matter of time before other insurers follow suit. Let's hope not. Always bear in mind that insurance companies have the potential of being really, really evil! Best - Nick in Sage > > Kitri......forgot to ask you if they required anything like diet > plans etc? > > Did you have to go to your pcp to get a referral or did you just go > to > > Rabkin for that? > > > > Judie > > > > > > Re: Health Net > > > > > > > Judie > > > > > > I have Healthnet PPO 10 and was approved for the DS with Dr > Rabkin in > > > 8 days! My surgery date is July 2. > > > > > > Kitri Olds > > > > > > > > > > > > > > > ---------------------------------------------------------------- -- > ---- > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2001 Report Share Posted June 28, 2001 Nick,. My friend who is seeking out the surgery with HealthNet PPO is a pastors wife.......would the policy be worded like an employers? Judie Re: Health Net > > > > > > > > > > Judie > > > > > > > > I have Healthnet PPO 10 and was approved for the DS with Dr > > Rabkin in > > > > 8 days! My surgery date is July 2. > > > > > > > > Kitri Olds > > > > > > > > > > > > > > > > > > > > ---------------------------------------------------------------- > -- > > ---- > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2001 Report Share Posted June 28, 2001 Dear Colleen; I also have Health Net. I don't have a referral yet. I am nervous to call them and " alert " them to the request. Do you think it would matter? I am very nervous about being rejected. Some are saying there are no rejections just slowdowns over speed bumps but that eventually with doctor letters, histories, etc. that the way will sooner or later be paved for at least 70% of the bill. I have also heard that going to the first consultation and letting the operating drs office fight the insurance battle. Any thoughts? - Melodie --- wehrco@... wrote: > Just because one persons HealthNet covered wls, > doens't mean that > another person's policy will. Each company (if it's > thru an > employer) purchases a contract that stipulates what > is and isn't > going to be covered in the policy/contract. > So she is going to have to READ the policy prior to > 'getting her > hopes up', as her specific policy MAY have an > exclusion > Colleen - Iowa > BPD/DS 1-15-01 > Dr. Buchwald u of MN > -7? haven't weighed in a while > > > > > > > > > > Kitri......forgot to ask you if they required > anything like diet > plans etc? > > Did you have to go to your pcp to get a referral > or did you just go > to > > Rabkin for that? > > > > Judie > > > > > > Re: Health Net > > > > > > > Judie > > > > > > I have Healthnet PPO 10 and was approved for the > DS with Dr > Rabkin in > > > 8 days! My surgery date is July 2. > > > > > > Kitri Olds > > > > > > > > > > > > > > > > ------------------------------------------------------------------ > ---- > > > Quote Link to comment Share on other sites More sharing options...
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