Health Net HMO, anyone?

[Calif_Princess 0]

Does anyone have Health Net HMO? I do and when I went to my PCP 3 months ago to ask about the band weight loss surgery he told me that I have to have 6 months of diet and nutrition classes (thank goodness they're free...but their not in my town...so gas....at $4.50 a gal....not good).

It was explained to me that the 6-month diet classes are required by my MEDICAL GROUP/Dr. and has nothing to do with Health Net, or the Dr. that will eventually put the band in.

I have been faithfully going to the classes now for two months now but suddenly got a horrible thought that maybe the surgeon himself will also have long term requirements (like another 6-month diet) or maybe even Health Net will require their own long term diet....????

So last month I called my dr.s office to MAKE SURE that the surgeon will not also require another 6-months of diet classes or if Health Net will not have their own requirements also. I requested the surgeons name or phone number so I could call their office to make sure. But I am not allowed to even know who the dr. is that will be performing the surgery until AFTER the 6-months of diet classes are finished and I go back to my PCP and get a referral!!! What's the big secrete??? But the lady in the office assured me that this surgeon will not require any further supervised diets..... Yeah, like I'd be able to hold her to her word........

Has anyone else who has Health Net HMO run into this problem? Do you know if Health Net HMO has any diet requirements that I'd have to adhere to after I've already finished my PCP's required 6-months of diet classes?? I'm so afraid of doing these diet classes for 6 months, then come to find out that Health Net requires me to see my PCP for supervised diet for another 6 months or 8 or 9 months and that I have to lose like 60 pounds before surgery or something stupid. I'm totally lost....:confused2:

Any help with these questions will be appreciated. :thumbup:)

[cella 0]

I have health net hmo and i am in sacramento. My pcp did not require any type of diet he just put in the request for the consultation with a lab band dr. about 2 weeks later I got the approval dr. office called me to mailme patient registration paperwork, I filled it out got a call from the lap band office 3 days after I mailed in my forms. That was July 11 I got the call they sent me to a group sppt meeting for 7/12/08 and a appt with the dr on 7/21/08. I went to the sppt meeting at sutter roseville on 7/12/08 part of the requirement and i am waiting for my appt. for 7/21/08 to see what else I have to go through but I think that it is going fairly quick for me. I have heard that health net does notrequire a 6 month diet and I asked the lapband office and they said that was correct no 6 month diet required I think your pcp doctor is making you do that themselves.

Edited July 14, 2008 by cella

[cella 0]

oh I forgot another thing I know who my dr. is for my lap band ,I picked the office dr. waldrep in roseville. I told my pcp who i wanted to go to and that was that no problems. Is your pcp in favor of wls or do you think they are making it a little difficult for you?

[Calif_Princess 0]

oh I forgot another thing I know who my dr. is for my lap band ,I picked the office dr. waldrep in roseville. I told my pcp who i wanted to go to and that was that no problems. Is your pcp in favor of wls or do you think they are making it a little difficult for you?

Cella, Congrats on your quick timing!

Yes, It's my pcp that's making me do this....and he won't even tell the name of the dr. that he will eventually refer me to!

Well I did report his office to Health Net and to the Dept of Managed Heath Care. My ankles are swelling so bad and my fingers get tingly and the tips go numb sometimes so I'm really starting to worry....this 6 month diet nutrition class is stupid.:cursing:

[cella 0]

why don't you change dr's? If you do it before the 15th you can see your new dr Aug 1st Are you in sac i can give you my drs name. Im with sutter independent.

[Calif_Princess 0]

why don't you change dr's? If you do it before the 15th you can see your new dr Aug 1st Are you in sac i can give you my drs name. Im with sutter independent.

Thanks Cella!!

Unfortunately I'm way down south of you. I'm half way between L.A. and San Diego.

There's two major medical groups in my area. Most dr.s belong to one of these groups. I thought of that too when my dr. first said I had to go through the 6 month nutrition classes. So, when I came home from his office, I called the other major medical group and asked what policy they had regarding required diets before WL surgery and they also require a 6 month diet.......so even if I chose a dr. in a different medical group I'd still have the same problem.

A few years ago when I got very ill and couldn't find a dr. that would help me I finally had to go way out of town and pay cash and then when he immediately put in the hospital, which was even farther out of my "network area" we had to claim it was an emergency (which it was, I would have died eventually) in order for Health Net to pay for hospital costs since it was out of my area. I tried to change my pcp to this dr. that helped me but Health Net said no way since he's farther than 30 miles from my house (which is stupid because almost all dr.s are more then 30 miles from my house since I live in a tiny town in the mountains).

So unless the dr./medical group lifts the stupid requirement I'm doomed.....:thumbup:

[lsanderson 0]

Hi Cella! I'm just starting the process and I'm with Sutter Medical Group as well. Do you mind if I ask who your PCP is?

[cella 0]

Dr. Marasigan in elkgrove, Ca his # is 916-685-7500

[lsanderson 0]

Thanks! I actually had my first appt with my Primary Care Physician on Tuesday and she gave me the referral no problem. All I have to do is the psych eval which I have scheduled for next week. It's all been very smooth so far and will hopefully continue that way. I go for my patient seminar with the surgeon on 8/11. I've been calling my insurance almost daily checking on things making sure they won't have a problem with approving it and so far so good! Now I'm just getting very nervous. It's one thing to think about doing it, it's another for it to actually be happening!

[Calif_Princess 0]

Thanks! I actually had my first appt with my Primary Care Physician on Tuesday and she gave me the referral no problem. All I have to do is the psych eval which I have scheduled for next week. It's all been very smooth so far and will hopefully continue that way. I go for my patient seminar with the surgeon on 8/11. I've been calling my insurance almost daily checking on things making sure they won't have a problem with approving it and so far so good! Now I'm just getting very nervous. It's one thing to think about doing it, it's another for it to actually be happening!

Oh wow, it looks like things are going smooth for you!!! Lucky you!! Yesterday I sent my dr, his medical group and Health Net a copy of the study done by Calif Managed Health Care stating how ineffective, and in some cases dangerous, the mandatory 6month diet is. Hopefully Health Net will tell my PCP's medical group where to stick their 6 month diet and I can get a refurral to the surgeon in the next month. Then I can start all the tests and the psy evaluation and hopefully get a surgery date by the fall!!! I don't know if it's just wishful thinking though.....:biggrin:

[taylormomto6 0]

They won't require another 6 month diet. This one will carry over, as long as you attend all sessions. Now my medical group also requires another 3 month class after the 6 month one, but they've been upfront on that.

I don't have HealthNet, but my sister in law does. We live in the Bakersfield area and she has a different medical group than I do. She was just approved after one appeal without a 6 month diet, they never even mentioned it. If I had known hers doesn't require the 6 months, I'd have gone with them to begin with, my PCP belongs to both groups, but I think Blue Shield does require the 6 months anyway, so I figure I'll complete it and if they deny me even after appeals, I'll switch then :biggrin:

Good Luck to you,

Cindy T

[JessiccaMarie 0]

I have Healthnet Arta and i live in Huntington Beach, my PCP just gave me the reffereal with no problems. I am going to Dr. Ali in Fountain Valley, as far as I know, Healthnet does not require a 6 month diet, I didnt have to do it. They require a psych eval and i think thats it. My surgeaon requires some scheduled classes and a doctor talk but that sucks! change your PCP complain, it gets things done ! if you need any help let me know.:cursing:

[Calif_Princess 0]

They won't require another 6 month diet. This one will carry over, as long as you attend all sessions. Now my medical group also requires another 3 month class after the 6 month one, but they've been upfront on that.

I don't have HealthNet, but my sister in law does. We live in the Bakersfield area and she has a different medical group than I do. She was just approved after one appeal without a 6 month diet, they never even mentioned it. If I had known hers doesn't require the 6 months, I'd have gone with them to begin with, my PCP belongs to both groups, but I think Blue Shield does require the 6 months anyway, so I figure I'll complete it and if they deny me even after appeals, I'll switch then

Good Luck to you,

Cindy T

I think it's so stupid that all these different groups and companies require different things.....the medical group, the PCP, the health insurance and then the actual surgeon...c'mon people!!!:wink2:

[Dayle 0]

I'm a Sutter patient with Healthnet HMO and have seen my PCP. He sent in for my referral to Bariatric Surgery 15 weeks ago and I have not heard anything yet. I called my PCP a couple of weeks ago and she called Healthnet. I'm calling her again tomorrow and asking for Healthnet's phone number. At the very LEAST I want to know how much longer I have to wait for approval. this is rediculously long!

Dayle