Insurance process - how many approvals do you need?

[OregonBarbie 0]

Hi, I am new here. I am on Oregon Health Plan - My doctor sent in a referral for Bariatric surgery Dec 4th and it was denied because I didn't have Type II diabetes. I filed an appeal and it was approved! I was so excited. But the approval says I am approved for consideration for surgery. I am assuming I have to pass through all the other hurdles before they actually approve it? I am on Kaiser and then are sending me to OHSU Bariatric Progam and it says I am approved for 1 appointment.. ? I am calling in the morning but it will break my heart if I have to fight for each step of the process..

UGH!

B

Edited December 28, 2015 by OregonBarbie

[Pinkgirl1234 761]

It's all so ridiculous the amounts of hoops needed...

Just for approval

[OregonBarbie 0]

Yep! and I called this morning. OHP kaiser referral says I have medical approval for 6 months.. OHSU didn't have the referral yet but I was told this morning that it is a 2 year waiting list for state insurance.. basically she said they don't have enough room to serve THEIR patients and everyone else, so non members (state)are put on a long waiting list.. THIS IS BS.. I will be on the phone all day .. Isn't that discrimination? I have a pre cancerous condition and the longer I wait the more serious it is.. so the OHSU rep basically said to me this morning that.. if someone on their insurance doesn't have any co-morbidity they will get in before me... because they get priority...

[OregonBarbie 0]

Partial Good news.. After my doctors appointment today, my doctor urged me to talk to the coordinator at OHSU and explain my circumstances. She did say they only get referrals and they don't have any chart notes. So I am sending those over. She is going to review my case and see if they can expedite my wait.. Keeping my fingers crossed..