San Francisco Bay Area Medi-Cal

[latido 177]

I just moved to the Bay Area and am looking for a group to follow-up with since my RNY in New York. I have Medi-cal + Anthem. Where did you guys go to?

The medical system seems so complicated. I found one group on Anthem's website, but when I faxed the referral and called for an appointment, they told me I have the wrong insurance. I don't know what to do!!

[Julie norton 2,850]

Greetings

There is a WLS group that meets once a month downtown on market st. It is led by Tara griffin or Griffith I believe

I live too far to continue, but really liked the people and moderator

Maybe look on Facebook for her

Good luck!

[latido 177]

Thanks. I'm looking for a surgical team right now. This is for follow-up care.

[Sharon1964 2,530]

What exact type of insurance do you have? You said Medi-cal + Anthem. Is that Anthem primary and Medi-Cal secondary? Is the Anthem product a Medi-Cal replacement plan? Is it an individual policy, or a group policy? Is it on or off the exchange?

[latido 177]

I applied and got approved for Medi-Cal (straight/full), but then they said I had to pick a managed care plan within thirty days. I had to call Healthcare Options, and pick on eof two choices. There was Alameda Alliance, and Anthem Blue Cross Blue Shield, so I selected Anthem. That's about as much as I know from this. Meaning, when I called some offices and asked about insurance, they all said, "Yes to Blue cross, no to the one from Medi-Cal". Nobody is taking Obamacare plans or government plans. Unless I don't know where to look.

I tried a referral to Summit and Sutter. Both said they won't take it.

[Sharon1964 2,530]

Okay, I'm going to give you lots of information, some of which you may already know.

Your insurance is Blue Cross Medi-Cal HMO. That means that a primary doctor is assigned to coordinate your care. Look on your insurance card and see if there is a pcp assigned to you (it will be printed on the card). If so, call them and make a "new patient get-acquainted" appointment. If there is no one on your card, you have two choices. The first is to start calling doctors off their provider list and ask if they are taking new Blue Cross Medi-Cal patients. The second, particularly if you strike out with the first, is to call the customer service or member service number on your card and tell them you are having difficulty finding a primary care doctor and you need their help. They will help you with this.

At your first appointment with your new primary care provider (PCP), tell the doctor that you had the surgery and you would like a referral to a surgeon who will follow you post-operatively. Then one of two things will happen. The first is that they will refer you to someone - a pcp that takes your insurance will know who else takes your insurance. When you have an HMO, your pcp refers you, you don't self-refer (except in a few narrow cases such as gynecology and mental health). The second possibility is that the doctor may have a particular interest in bariatrics and may say that they would like to follow your care themselves.

Since you are close to a year out from surgery, this part will most likely not apply to you. I haven't looked up the "global period" for the surgery. Every surgery has a global period where ROUTINE post-op care is included in the payment for the surgery. This means unless you have a complication, your surgeon is NOT paid for the after-surgery visits. Every global period is different, but I am unaware of any that are a year long (which means I don't think this applies to you). For anyone else who finds themselves in this situation, closer to their surgery date, they may find that another surgeon is reluctant to take them on as they will only get paid for the first visit and then none others until you are out of the global period, unless there are complications.

I hope this helps.

[Sharon1964 2,530]

Not sure why they think the letter "H" followed by the letter "M" followed by the letter "O" should be censored, but that's what the censored words are above, the abbreviation for Health Maintenance Organization.

[latido 177]

I thought that was funny too, lol. Well, this is helpful. Except, until my Anthem card comes in the mail (and it took 6 weeks to kick in!), I went to a private PCP locally. He wrote a referral to Summit, but they wouldn't take me. I am appalled that they wouldn't see me as a follow-up, because they wouldn't get paid. That is sick.