Health Net Blue Gold

[oceangirlpc 68]

Please tell me if anyone has used Health Net Blue and Gold. It is very specific but need to know if anyone has used them and how difficult or easy was it? Thank you

[2goldengirl 2,076]

HN medical policy is the same for B & G as any other member, what is limited is your network. Are you in the Bay Area, or Sacramento? I can check to see which facilities you need to use that offer bariatric surgery.

Here is a link to HN's national medical policies: https://www.healthnet.com/portal/provider/content/iwc/provider/unprotected/working_with_HN/content/medical_policies.action

The policy will open as a .pdf.

Your medical group/IPA will actually be the ones reviewing and approving your surgery, but they have to use HN's medical policy.

I hope this helps!

[oceangirlpc 68]

I am in the sacramento area. It is such a pain to even get in to see the doctor for a consultation. They keep saying that HN has to send an authorization code to them. My clinic states that HN does not need to as they are in their Network and i'm in the middle going back and forth trying to hurry things along. Very unorganized and no one seems to know what they're doing. I'm frustrated. Next open enrollment probably changing plans.

[2goldengirl 2,076]

It isn't the Health Plan that's your problem, it's the Medical Group or IPA that you're in. I'm confused when you talk about "my clinic" and "the doctor". which is which? Your medical group/IPA handles your day to day authorizations, Health Net just pays some of the claims and writes the policies. I changed surgeons because the first one had an office staff that was chronically disorganized. You can do the same. I don't know which surgeons are in-network for you unless I know which medical group you're with.

HN B & G has contracts with the Mercy hospitals in Sacramento. Here is a link to their bariatric surgery info: http://www.dignityhealth.org/sacramento/services/surgical-services/bariatric-surgery/bariatric-surgeons

Dr's Eslami, Shadle, Gatschet, and Machado all have privileges at both hospitals and are part of their program. I think they all have their own offices and staff.

There are two different ways for you to see a surgeon: ask your PCP for a referral, or your PCP requesting an authorization. An authorization shouldn't be required for referral to an in-network surgeon, but in the case of bariatric surgeons, it often is. You need to go through your PCP to get the ball rolling, that's just the way it works.

I know Dr. Eslami wants all his patients to have completed all health plan requirements before he sees patients for an initial consult. Your health plan isn't making the decision about your surgery, but your medical group/IPA have to use the health plan criteria in making their decision. Dr. Eslami expects PCP's to order necessary preop testing ahead of time so all that is done before he sees patients initially. His office communicates directly with the PCP's to get this done.

I used to work with clients out in the Central Valley, many of who surgeries done by Dr. Eslami, so I'm most familiar with his practice.

I hope this helps!

[oceangirlpc 68]

Hi there, yes seeing Dr. Eslami on the 28th of April....finally. I have had my ekg done and 6 month wait. I went to his seminar and dietician class and support group. Sorry I was sounding so confussed but this has been so new to me. I had Laura Machado only to find out she would not take Health Net blue and Gold. I'm so grateful that Dr. Eslami is and my clinic in Woodland where my primary is has been working with Dr. Eslami's office. I think finally i'm heading in the right direction. I still have to have my endoscopy and psych eval before seeing Dr. Eslami. I'm definately anxious to get all done. Thank you for information. I appreciate it.

[2goldengirl 2,076]

It can be awfully confusing! I'm glad things are sorted now. OH - one more thing to be aware of. If Dr. Eslami's office tries to charge you an "administrative fee", decline to do so. All you have to pay is your usual doctor's visit copay. Also don't let his office try to tell you that you have to purchase supplements or shakes from his office. I don't think they're doing this any more for their H M O patients, cause we caught them at it

Good luck!

Hi there, yes seeing Dr. Eslami on the 28th of April....finally. I have had my ekg done and 6 month wait. I went to his seminar and dietician class and support group. Sorry I was sounding so confussed but this has been so new to me. I had Laura Machado only to find out she would not take Health Net blue and Gold. I'm so grateful that Dr. Eslami is and my clinic in Woodland where my primary is has been working with Dr. Eslami's office. I think finally i'm heading in the right direction. I still have to have my endoscopy and psych eval before seeing Dr. Eslami. I'm definately anxious to get all done. Thank you for information. I appreciate it.

[oceangirlpc 68]

actually when I went to the dieticians class and support group they were pushing thier Vitamins. So decline the Admin fee...I will thank you. You are so knowledgable. I appreciate it. I am supposed to get the psych eval BEFORE my consultation with Dr. Eslami right? I have scheduled for April 8th with psych eval and my clinic was confused thinking Dr. Eslami needs consultation first....I was like Why am I the one who needs to know what is going on between my clinic and Dr. Eslami's office. So aggrivating.