I need advice on how to navigate insurance/find a surgeon

[PammyC 0]

I'm finding this whole insurance thing pretty convoluted and a little confusing. I've had Kaiser for my whole life, so dealing with networks, medical groups, referrals and yada yada is a new thing for me. Hopefully someone can clarify this for me:

I'm interested in a particular surgeon, Dr. Quebbemann in Los Angeles.

I don't have a primary care physician yet. I have Medi-Cal (with LA Healthcare) though, and Quebbemann does take Medi-Cal. I just spoke to an agent from LA Healthcare and she said it's unlikely that Quebbemann would see me if my PCP isn't in the same medical group as him.

Is my best option to call Quebbemann's office and see what Medi-Cal doctors he recommends?

I'm not dead set on Quebbemann, but I saw such great reviews of him and he would be a great fit. But I'm happy to explore other options. Seeing as how I don't have a PCP yet, my options are practically wide open. Should I start by finding a surgeon I want and work backwards? Or should I just pick a PCP and see what surgeons will be able to work with me based on that?

[Introversion 1,876]

Note: I am a case manager for a major insurance company, so my response is colored by my knowledge of the health insurance industry.

For those who may not know, Medi-Cal is California's version of Medicaid. The California Medical Assistance Program (a.k.a. Medi-Cal) is California's Medicaid program for lower income persons, disabled people, kids in foster care, indigent pregnant women, and childless adults with incomes less than 138% of the federal poverty level.

If you are on Medi-Cal/Medicaid, you've got to take whomever you can get as far as surgeons are concerned. Just pick a PCP who will refer you to a reputable bariatric surgeon to expedite the process.

If you insist on being sleeved by Dr. Quebbemann, you might be waiting a very long time. It's an unspoken reality that Medicaid/Medi-Cal patients are the lowest priority for surgeons due to pitifully low reimbursement rates, so pick a PCP and be open to a variety of good bariatric surgeons. You cannot be picky with Medi-Cal.

Good luck to you.

[PammyC 0]

17 minutes ago, Introversion said:

Note: I am a case manager for a major insurance company, so my response is colored by my knowledge of the health insurance industry.

For those who may not know, Medi-Cal is California's version of Medicaid. The California Medical Assistance Program (a.k.a. Medi-Cal) is California's Medicaid program for lower income persons, disabled people, kids in foster care, indigent pregnant women, and childless adults with incomes less than 138% of the federal poverty level.

If you are on Medi-Cal/Medicaid, you've got to take whomever you can get as far as surgeons are concerned. Just pick a PCP who will refer you to a reputable bariatric surgeon to expedite the process.

If you insist on being sleeved by Dr. Quebbemann, you might be waiting a very long time. It's an unspoken reality that Medicaid/Medi-Cal patients are the lowest priority for surgeons due to pitifully low reimbursement rates, so pick a PCP and be open to a variety of good bariatric surgeons. You cannot be picky with Medi-Cal.

Good luck to you.

Okay, that makes sense to me! Thank you for that information!

Would you say the same goes for finding PCP who have a reputation for handling patients who have bariatric or obesity focused needs?

I haven't particularly searched to see if there are any, but it was in the back of my mind. The PCP I'm looking at now just has a reputation for being progressive in treatment and actually listening to what patients need. That sounds favorable to me, but thought I may be able to shoot for the stars lol