I need a particular surgery, and I requested my insurance (LA Care with MediCal) to refer me to someone in my network. My PCP and I have been specific in our written requests to my health plan, detailing what type of surgery I need, but this is the second time that we’ve just been given doctors who don’t do it.
What do I do?
Look up the surgery in your EOC and find out what the coverage is, plus any pre-coverage requirements.
If your PCP is the one recommending surgery, insurance probably wants someone else to review first before they will put you with a surgeon.
I can’t edit my post, but I want to clarify that by “doctors who don’t do it,” I mean doctors who don’t perform the procedure I need at all. It’s not that they don’t want to; they just don’t do it.
Get the names of the Drs who actually do the surgery. Call and see if the accept your insurance. Request your primary physician refer you.
Absolutely do NOT call the doctors office to find out if they take your insurance/if you’re in network.
Sometimes, before they approve a procedure as medically necessary, they’ll send you to other specialists to try other options first. This way, your record will show that those doctors couldn’t help, making it more likely that the procedure will be approved as necessary.