Question:
Who has been approved w/PrimeCare as the network in CA?
I was wondering how it was to be approved by them. I have One Health Plan insurance, but from what I understand you must go through Primecare first for them to okay it. Was it hard to get them to approve it? I have a BMI of 47, not many comorbities though. I am still going through the process of trying to referred to the dr. Thanks. — Kerri 4. (posted on April 10, 2003)
April 10, 2003
Hi Kerri- I have Primecare Medical Group here in So. CA.I got approval on
my surgery on the first try. I am having a problem with them now though.
When I went in to the hospital to pay my co-pay, they (hospital) contacted
Primecare to ask what my co=pay would be. They (Primecare) told the
hospital that I had a 250.00 deductable and the remaining balace was 100%
covered. Well... now they are billing me for 2500.00 hospital and they only
made a part payment to the DR.Which I am now resonsible for!!! I am
fighting it! Otherwise my surgery and weight loss experience has been
wonderful. I had my lap rny surgery on Oct. 16,2002 and I have lot 102
lbs. I am thrilled and would definitly do it over again. Where in CA are
you and who is your DR. Good luck to you. Denise
— Denise J.
April 10, 2003
I live in Moreno Valley. I haven't been referred yet, but I am in the
process of doing what my PCP wants me to so that I can get referred. I
will probably have Dr. Sanderfer. I am hoping that I can finish this month
and get a referral in May so that I can make my first consultation
appointment after that. Sounds to me like your insurance is messed up. I
would definitely fight it. Do you have an HMO? Who is your insurance?
— Kerri 4.
April 10, 2003
Hello: I am 17 mos post op and Dr. Sanderfer did my surgery. I had
PrimeCare Corona med group and my insurance was Pacific Care
POS....Primecare was the determining party as to whether I got my surgery
or not. They turned me down 2 times before I got my approval and then my
approval was only after threat of a law suit and everything else. I had
only a $10 co payment for my surgery and have had no other bills
since....PrimeCare was a REAL PAIN IN THE BUTT...but I had to really stay
on top of them to make things work....Good luck....
— Joi G.
April 15, 2003
I had been denied by one group and switched to Primecare and was approved
the first time. I also had my surgery done by Dr. Sanderfer. Primecare
didn't give me any problems and I had no co-pay. I did send a letter with
my doctor's request though explaining to them why I felt this surgery was
necessary for me.
— Kendell C.
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