Hey everybody!
I havent been around for while because of how sad I have been. But today my big sister told be to get off my butt and take care of business.
I have been doing my supervised diet with my pcp since May. As of November 6th my 6 months is up and all of my qualifications have been met. Last minute my pcp said I need to go to more classes for 6 months to another medical group that is 45 minutes ( one way) away. Classes are once a week for the first 3 months then twice a month for the last 3. At first I was shocked and mad. I have posted about this issue before. But now I have more details.
After being upset, I came around. But I still couldn't get to the classes. I have a 5 year old and a 1year old. My husband comutes and I have a hunk-o-junk car. Plus, gas money. oh yeah, Im a stay at home mom. So, now im not upset about the time. Im upset that I can do the classes. So I told that to my PCP. I said if classes were local I would have no problem.
Next problem, I asked for a referral to see the surgeon that I picked so maybe they could push the surgery. ( i have met and exceeded all of my AETNA *** requirements.) My pcp said that the medical group has denied that request as well. WTH!!! If i had a referral to see my surgeon , they could submit all of my paper work and I would have a date. Im %100. I have read Aetna obesity policy bulletin 10 times! I never received a denial letter for my referral. I feel like my PCP does not want me to have surgery and that she never EVEN submitted a referral request.
This is where my sister come into play. She know Doctors and has work in doctors offices for years. She thinks the medical group wants to drag it out to the new year. Every year I believe they get a lump sum of money for me being with there medical group.
I wrote a letter that I am mailing certified tomorrow to my pcp. All i want in this world is a referral to my surgeons office!
Here is the letter:
To whom it may concern;
This is a formal request in writing. To my understanding, I have been denied a request for a referral to see Dr. J******. I do not know the reasons for the denial. This is my second attempt in receiving a referral.
Based on Aetna, I have met and exceeded ALL of the policy bulletin requirements.
I have contacted Aetna and they don’t understand why your office is WITHOLDING my referral.
In addition, I was told that Dr. **** was not contracted with ***** Physician’s. I have verified with Aetna and **** Surgery’s contract manager that Dr. J***** IS in fact contracted.
I personally feel my condition worsening and need to see a specialist. This is urgent and I would appreciate a prompt written response for my referral to See Dr. J********.
Attached is a copy of Aetna’s Obesity Surgery Policy Bulletin.
Kind regards,
What are the laws about medical groups and them making up there own rule and completely ignore Aetnas policys?
Where is my denial letter?
thank you all for reading this and your responses :smile1: