Anthem Blue Cross: A Resolution In Sight?

[Sumaire 75]

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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[2goldengirl 2,076]

Preferred will know who you're capitated to. Ask Preferred IPA the question - who is in-network for bariatric surgery at my capitated hospital? Preferred will be doing your authorizations.

For now, forget about asking for a variance, you are not the only bariatric member they have, and they undoubtedly have a system for routing bariatric patients. Your PCP's office ought to have done this much for you.

They also probably have one person there who deals with bariatrics - that's the person to talk to.

[Sumaire 75]

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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