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Insurance/surgeon requirements, healthnet



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Hello! I started in May 2021 with my PCP doing the medically supervised diet. Next month will be my 6th and final month and I have lost 10 lbs. I need to lose another 6 lbs to meet the 5% weight loss requirement.

I’m in San Diego and my hospital is UCSD La Jolla through Healthnet Medi-Cal.

In these past months, I have done a chest xray, esophagus xray, esophageal impedance test, blood work, EKG, met with surgeon, met with hospital bariatric doctor and I just had my psych evaluation. The last thing I need to do is a sleep apnea test. I called to make an appointment for a consultation and the next appointment isn’t until March 2022!! I am so frustrated since I’m almost done with all the requirements and I was hoping to have the surgery in the next few months.

I spoke with my coordinator and bariatric doctor. They said I can be put on a waitlist if there are any cancellations for an earlier date. They also suggested I call my PCP to see if she can get me a referral to a sleep clinic outside of UCSD. Waiting to hear back from insurance for approval.

If they say no, I am changing insurances. I asked my coordinator if the sleep apnea test was a requirement from my insurance and she said no! The bariatric doctor at UCSD requested I have one done. Not sure why though? I don’t snore or have issues sleeping. Ugh

Does anyone know if I do end up switching insurances, do I have to start over or will everything be transferred over? I do not want to wait until March 2022 :(

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It was part of my requirements too, but I'd had one done earlier in the year.

It's because so many people have undiagnosed sleep apnea, which can be very dangerous while under anesthesia. I had to prove my APAP settings for the anesthesiologist's office.

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Update: I switched to Molina and saw a different surgeon. He said since I already completed the 6 month supervised medical diet, all I have to do now is the pre-op visit, that’s on 11/18 and then they will schedule me for surgery. He said most likely middle of December. Super excited :)

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On 10/21/2021 at 11:11, aannaa said:

Update: I switched to Molina and saw a different surgeon. He said since I already completed the 6 month supervised medical diet, all I have to do now is the pre-op visit, that’s on 11/18 and then they will schedule me for surgery. He said most likely middle of December. Super excited :)

I have Molina and when I contacted my surgeons office to inquiry some information on the sleeve they had me pre-approved for surgery within 2 days and called to schedule my first appointment with the Dr. They have been great for me - I am super happy with them and so far they covered everything 100%. I did have $160 to the hospital for my endoscopy and a $40 copay for the endocrinologist. Also, if you do the sleep clinic at home not in a clinic they only cover SNAP at home sleep study company. They covered all of it but $47. Just FYI because it took me a week to get that figured out. All I had to do was see a endocrinologist, sleep study, endoscopy, see a nutritionist twice, and see the psychologist. Only 3 months for me from start to surgery I’m December . But my BMI is on the boarder of surgery however my type 2 diabetes is in the 300 even when I was 18 and 105 pounds so that’s why they are pushing it through so fast. I’ve had really high that drops real low where 911 comes. We can’t get it under control and it started with the focus vaccine in March - I had a severe reaction and was hospitalized from the vaccine. But I absolutely love Molina. Good luck with everything!!!

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