The Roller Coaster Ride Begins!

[Guest guest]

OK, I got the approval to see Dr. Ostroff in SF.

Knowing he works at UCSF and Dr does only RNY,

I called the Marin IPA (HMO) today to ask that I be

allowed to see Dr. Rabkin.

I get transferred to the Nursing Director or something

and as soon as I said Dr Rabkin, she knows what's up.

She says she's not sure if my Pacificare plan covers

the DS since it's " experimental " . (yeah right). I

told her I would appeal it if that's the case because

I know of other people with Pacificare who has had the

DS. (How can it be experimental on one plan but not

another?)

She said she'd call me tomorrow. Ten mins later, the

phone rings and she leaves a message that she looked

up my policy and WLS is covered but only the Band and

the RNY. No DS. She gives me the Pacificare number

to appeal it.

Oooooook, so I call Pacificare and talk to someone who

looks up the CPT code 43847 (Duodenal Switch). He

says, no problem, it's covered. I had him check it

three times. I said, what do I do now? He says to

call back Marin IPA and have them call him, which I

do.

How confusing! Now I'm on pins and needles, hoping

Marin IPA doesn't try to talk Pacificare out of

allowing the DS. Jeez, this is nerve-racking.

I did get both names in case of an appeal.

Just had to vent.

=====

Dee

Waiting for Ins. Co. Approval

313/Want to be 165

__________________________________________________

[Guest guest]

Just had to vent.>>>>

Good for you, Dee! You are getting somewhere!

Judie =)

[Guest guest]

Dee,

For what it's worth what you are describing is not uncommon. Hang in there!

Keep on them till you get what you want and deserve. Documnet everything. It

is of so much help if an appeal is ever needed. When I help fight a case the

more documentation I have the better chance of approval in the end! HANG IN

THERE its worth the fight!

Deanna

300lbs bmi 50 day of surgery 02-15-01

200lbs. bmi 32 as I sit here now !!!

THANKS GOD !!!! http://www.duodenalswitch.com/Patients/Deanna/deanna.html

The Roller Coaster Ride Begins!

> OK, I got the approval to see Dr. Ostroff in SF.

> Knowing he works at UCSF and Dr does only RNY,

> I called the Marin IPA (HMO) today to ask that I be

> allowed to see Dr. Rabkin.

>

> I get transferred to the Nursing Director or something

> and as soon as I said Dr Rabkin, she knows what's up.

> She says she's not sure if my Pacificare plan covers

> the DS since it's " experimental " . (yeah right). I

> told her I would appeal it if that's the case because

> I know of other people with Pacificare who has had the

> DS. (How can it be experimental on one plan but not

> another?)

>

> She said she'd call me tomorrow. Ten mins later, the

> phone rings and she leaves a message that she looked

> up my policy and WLS is covered but only the Band and

> the RNY. No DS. She gives me the Pacificare number

> to appeal it.

>

> Oooooook, so I call Pacificare and talk to someone who

> looks up the CPT code 43847 (Duodenal Switch). He

> says, no problem, it's covered. I had him check it

> three times. I said, what do I do now? He says to

> call back Marin IPA and have them call him, which I

> do.

>

> How confusing! Now I'm on pins and needles, hoping

> Marin IPA doesn't try to talk Pacificare out of

> allowing the DS. Jeez, this is nerve-racking.

>

> I did get both names in case of an appeal.

>

> Just had to vent.

>

>

>

>

>

> =====

> Dee

> Waiting for Ins. Co. Approval

> 313/Want to be 165

>

> __________________________________________________

>