Sumaire

I would hope that the insurance company she works for actually knows what surgeons are connected to what hospitals, or even if that hospital offers bariatric surgery in the first place. My former provider apparently had no clue. Meanwhile, they were the ones who kept insisting that I go to a hospital that did not offer it.

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Thanks. I hear he's remarkably tall. It's a Center of Excellence, right?

I've recently changed providers and PCPs just so I could get the surgery. My old provider was apparently insane.

They picked the wrong fat lady to screw with.

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After several twists and turns, I've chosen Dr Lamar for my surgery.

Did you end up having yours with him?

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I'm having to change providers, and thus my PCP, in order to even HAVE surgery.

Has anyone here used Dr Troy Lamar for their surgery? I chose a particular PCP because he and Lamar both are in the same network. It was pretty bass ackward, because I chose the surgeon based on his taking my plan, and then chose my PCP from a list of doctors who are also on it.

(I can't help but think of the Simpsons character Troy McClure when I think of or say his name. Is that bad?)

FWIW, If you have Preferred IPA for your provider and you're still waiting on approval, make sure your capitated hospital even offers Bariatric surgery. My former capitated hospital does not, although PIPA kept insisting I find a surgeon who performed it there

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I know 6 people who had the surgery through welfare medical. This is absolutely not acceptable.

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??????

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I'm assuming that the poster feels that only people who have insurance OTHER than state-paid should have their bariatric surgery covered.

I disagree with that opinion.

Well, it's resolved for now.

I've changed providers and thus doctors, aftering find a surgeon who accepts my insurance and then finding a doctor who is affiliated with the same insurance provider.

It turns out that Monterey Park Hospital doesn't even support bariatric surgery, so Preferred IPA was making a requirement that could never be fulfilled in order for me to get surgery. I'll be making a formal complaint about that, as I can't be the only person who has been affected by this deliberate stonewalling.

Hoping for a fruitful relationship with my new insurance provider.

Preferred IPA are the ones sending me to surgeons who don't do surgeries at the hospital they say I am capitated to. As far as I can tell, there are no doctors who accept my insurance who also have privileges at Monterey Park Hospital.

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Gets better. There are no doctors who practice at Monterey Park Hospital (where Preferred IPA says I'm capitated) who accept Anthem Blue Cross.

You'd think the insurance company would know that already.

Meanwhile, Anthem Blue Cross says I'm capitated to Alhambra Hospital, which doesn't DO bariatric surgery.

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Oh, this gets juicier.

I made some phone calls today.

The insurance company (Anthem Blue Cross) says I'm capitated to one hospital, while the approving people (Preferred IPA) say I'm capitated to another.

I called both hospitals, who told me that they're part of the same system, but NOT the same hospital. But this is where it gets even more interesting...

The one my insurance company says I'm capitated to does NOT do bariatric surgery, and one the approving body says I'm capitated to DOES do it, but I was unable to find any doctors who both practice there AND take my particular insurance.

I may have found my way to demand a variance and get my surgery with the surgeon I want.

Preferred IPA may enjoy watching me run around in circles, but again, they've picked the wrong fat lady to f around with. I don't take "no" for an answer.

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Oh, I'm sure it's all about trying to get people to give up. I'm a stubborn fat lady, though. They've picked the wrong evil old lady to mess with.

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I need one that does surgery at Monterey Park Hospital and has a deal with Preferred IPA.

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I'm sitting on my arse and waiting for my insurance to send me to a surgeon who they will actually cover for the surgery.

So far, I'm zero for two on that bet.

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The insurance company's response to the doctor's staff about this was that it wasn't the company job to send me to a doctor who had privileges at the hospital to which I am capitated.

THEY sent me this particular doctor. Not my GP.

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My kid isn't happy at all that I'm planning to have the surgery, but I'm not going to let her talk me out of it.

Mainly, she's worried that I might die as a result. Trust me, I wouldn't be doing this if I thought there was something I had to worry about.

I hope things go well at work for you.

And at this point, my GP's office is submitting a modified request specifying that the surgeon chosen actually has privileges at the hospital to which I am capitated.

Got their letter today denying my surgery, saying that my current surgeon doesn't do surgeries at the hospital to which I am "capitated" (gawd, but I loathe that word).

Funny, but they've been approving my monthly visits to my surgeon since last August, a surgeon THEY assigned me to when this whole thing first started in earnest. Now they're saying No, because he doesn't practice at a specific hospital.

They sent me a referral to a DIFFERENT surgeon, and lo and behold, when I told the lady on the phone at that office what the denial letter said, she told me that this new surgeon doesn't practice at that hospital, either.

WHAT THE HELL ARE THESE JACKASSES TRYING TO PULL???? This is <insert really nasty expletive here> and I'm tired of the games.

They've picked the wrong ridiculously fat lady to screw with, and I've got a call in to Anthem Blue Cross' appeals department about this. I also mentioned to the nice lady at ABC that Preferred IPA had denied every surgery request for other patients that my preferred (see what I did there?) surgeon has sent them since this last January. The lady at ABC was nonplussed when she heard what's been going on.

We'll see what happens, but I'm more than a little hot under the collar about all of this mess.

Thanks for listening.

Deleted duplicate.

You don't have high blood pressure, sleep apnea, or degenerative arthritis in your spine/hips/knees (dumping the weight can help to slow that down)?

Just a thought...

Called my doctor's office a couple minutes ago.

"Your ears must have been burning, we were just talking about you."

Seems that Preferred IPA gave them a call this morning to tell them that they are working on a LOA (whatever that is) right now.

I guess my phone calls must be having an effect on things.

My doctor is in Beverly Hills, so I'll be hitting the hospital closer to him. I'm not sure right now which one that will be. The issue I see in my near future, is that my insurance company is being a complete d*** about approvals.

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Spoke with ABS and LACare (who I have my insurance through, ultimately), and they have said that the two year requirement is bogus (not their words -- I'm paraphrasing).

They are having me have my surgeon's office submit a request and if/when it's denied, promptly filing a grievance to get this resolved.

Weird (but nice) when the insurance folks are actually TRYING to help you.

They seem to be going with the second example given, rather than the first one. Leave to them to be far more restrictive.

• The recipient has failed to sustain weight loss on conservative
regimens. Examples of appropriate documentation of failure of conservative regimens include but are not limited to:

Severe obesity has persisted for at least five years despite a structured physician-supervised weight-loss program with or without an exercise program for a minimum of six months.

Serial-charted documentation that a two-year managed weight-loss program including dietary control has been ineffective in achieving a medically significant weight loss.

Just heard from my Surgeon's staff today that ABS has raised the goalpost and is now requiring a TWO YEAR monitored group nutrition program before they'll approve GBS.

They also say that IPA hasn't approved ANY of their requests since the first of the year.

Any suggestions? I could be dead in two years, with my comorbidities combined with a BMI of nearly 50, if I don't have this surgery.

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I will, thanks. It's just frustrating, as I'm not a patient person.

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