Did I Mention How Much I Hate Rollercoasters?

[Guest guest]

Here's the latest, after 1.5 hours on the phone with

Marin IPA and Pacificare:

Per Kmetz (Marin IPA), Pacificare doesn't cover

the DS because DS Surgery includes lots of " extras "

that they don't cover. When I tried to find out what

the " extras " were, she couldn't tell me. She said to

call Pacificare and get past the Customer Service

reps, preferably to a Case Manager. By the way, she

seemed to find something funny about the whole thing,

laughingly saying how Pacificare has " been down this

road before " (DS vs RNY) and DS just isn't covered.

So I called Pacificare again and spoke to

Pereira. I asked to speak with a case manager and,

after being put on hold seven minutes, she came back

to tell me case managers don't talk to people about

this kind of surgery (!?!) OOOOOooooooooook, so then

we got down. I told her why I didn't want the RNY,

the differences between the two surgeries and asked

again to be referred to Dr. Rabkin. She said the

reason I was referred to Dr. O was because he was in

network. I told her the referral letter said he

wasn't. She said he's on the list to refer people to

when a doctor isn't found in-network.

So I asked her to look up Dr. Rabkin. Sure enough,

he's there too! I repeated my request to see him.

She said Dr Rabkin does other kinds of surgery and

that's why he's on the list. Then she kept telling me

that Pacificare does NOT cover the DS and they do not

approve it for anyone. I told her about these

e-groups and that Pacificare is definitely mentioned!!

I was put on hold three times for a total of 40

minutes so she could talk with her supervisor. In the

end, she said I couldn't even appeal the declination

as I wasn't actually declined in writing! (Jesus,

and ph!!!) She even said I was actually

approved for the RNY not just for the consultation.

(Oh joy).

I kept insisting on speaking with someone above her

and the 3rd time I asked she said " why didn't you

ask? " .... She put me on hold for 12 minutes and then

came back saying there were no supervisors available

but I could talk with a " mini-supervisor " ... I'm

thinking of Austin Powers and Mini-me now...

Finally, I get to talk with Yolanda Moffit and I

explained everything again to her. She said the DS

isn't covered and no one with Pacificare has had the

surgery, she's sure of it. I told her to log onto

obesityhelp.com and find out for herself! I also told

her about the delay tactics I've heard about

Pacificare and that they seem to be true. I told her

I didn't want to see Dr because of the type of

surgery she does and her inexperience. I asked

Yolanda if she would like the quality-of-life people

with RNY patients have vs. DS patients. Heck, I have

trigger points all over my head - there's no way I

could chew chew chew my food!

In the end, she said to see my PCP and have him write

out a specific request to see Dr. Rabkin and we'll go

from there.

I'm exhausted. How do you guys handle this?

Thanks for wading through this novel.

=====

Dee

Waiting for Ins. Co. Approval

313/Want to be 165

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