| HMSA |
|---|
| Insurer Policy |
HMSA |
| Insurer Status | First letter sent - still waiting |
| Comorbidities |
Depression |
| Source |
Meagan M |
| Aetna |
|---|
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/27/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
10 |
| Pre-Op BMI |
53.8 |
| Comorbidities |
GERD, osteoarthritis, hypothyroidism, PCOS |
| Policy |
Don't know |
| Comments |
They sort of "misplaced" my file for a few months, but once that problem was straightened out, they acted quickly to approve it. |
| Source |
Diane B |
| BC/BS HMSA |
|---|
| Insurer Policy |
BC/BS HMSA (Ipa) |
| Insurer Status | Approved after first letter (10/7/2006) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Comments |
I only had to write a letter and the dr.'s office took care of the rest. It was very quick and easy. |
| Source |
Abigail L |
| Blue Cross/Blue Shield |
|---|
| Insurer Policy |
Blue Cross/Blue Shield (PPO) |
| Insurer Status | Approved after first letter (11/08/99) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
67.3 |
| MD-supervised programs |
2 (44 weeks) |
| Source |
Carolyn P |
| Insurer Policy |
Blue Cross/Blue Shield (FED) |
| Insurer Status | Approved after first letter (10/09/99) |
| Surgery Type |
RNY - proximal |
| Weeks to approval |
1 |
| MD-supervised programs |
2 (16 weeks) |
| Comorbidities |
SLEEP APNEA,KNEE PAINS,LEG AND FEET |
| Policy |
Must be medically necessary |
| Source |
Rudy S |
| Insurer Policy |
Blue Cross/Blue Shield (PPO) |
| Insurer Status | Approved after first letter (05/16/00) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
62.5 |
| Comments |
5/12/2000
My primary care physician has sent the first letter. The insurer wanted to know why I can't have the procedure done in Hawaii. I listed my reasons: 1) Dr. Wittgrove's expertise and experience; I want the best, 2) No laparoscopic gastric bypass is performed in Hawaii at this time, 3) Only a few dozen bariatric surgeries performed in Hawaii State compared with hundreds at Alvarado Center, 4) I have discovered that the Hawaii hospital does not have enough large gowns, wheelchairs, and no bariatric beds; this is a dignity issue, 5) My insurer has approved surgery at Alvarado, by Dr. Wittgrove, for others who live in Hawaii and I want the same consideration.
5/16/2000
My insurance was approved less than three weeks after the first letter was sent. Thank you HMSA!
8/25/2000
I received a letter from HMSA, after surgery, that the anesthesia portion is not covered by my policy. I'm concerned (upset) that they did not inform me of this in a more timely way. How can surgery be approved without anesthesia? I pray that there will be no more big, bad surprises.
|
| Source |
Therese A |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | First letter sent - still waiting (04/10/01) |
| Source |
Norma F |
| Insurer Policy |
Blue Cross/Blue Shield (FEP) |
| Insurer Status | Approved after first letter (12/19/01) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
38.3 |
| MD-supervised programs |
1 0 |
| Policy |
Must be medically necessary |
| Comments |
The paperwork was sent in on Wed April 17th 2002. And I was approved by Fri April 19th 2002. And I got my surgery date on Wed April 24th 2002 for July 24th 2002. Talk about quick!! I love this insurance company!! |
| Source |
Dee B |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (04/17/02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
51.9 |
| MD-supervised programs |
2 (78 weeks) |
| Comorbidities |
Borderline diabetes, joint problems, UARS, BMI 51 |
| Policy |
Must be medically necessary |
| Comments |
HMSA responded within 2 business days. Thee were no problems or requests for additional information. When I called to check on the status of my request they not only told me I was approved, but went over my coverages in detail and let me ask whatever questions I liked. I think I have one of the better policies for state of Hawaii employees as it is through my Union. I don't think that the regular HMSA PPO covers nearly as much. |
| Source |
Michael B |
| Insurer Policy |
Blue Cross/Blue Shield (PPO) |
| Insurer Status | Approved after first letter (07/20/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Policy |
Don't know |
| Comments |
NO PROBLEM, THEY APPORVED MY BARIATRIC SURGERY AND ALSO MY PLASTIC SURGERY TUMMY TUCK |
| Source |
Norma F |
| Insurer Policy |
Blue Cross/Blue Shield (FPO) |
| Insurer Status | Approved after first letter (11/21/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
34.8 |
| Comorbidities |
sleep apnea, arthritis, acid reflux |
| Policy |
Must be medically necessary |
| Source |
Jerry W |
| Insurer Policy |
Blue Cross/Blue Shield (PPO) |
| Insurer Status | Approved after first letter (07/01/03) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
4 |
| Pre-Op BMI |
50.9 |
| Comorbidities |
Asthma |
| Policy |
Don't know |
| Comments |
HMSA was really easy to work with. I went in to see Dr. Balfour for the consultation visit and his office took care of all the approvals. I never needed to do anything, my BMI was 51 which meant I was automatically approved. |
| Source |
Cindy M |
| Insurer Policy |
Blue Cross/Blue Shield (HMSA) |
| Insurer Status | Approved after first letter (05/01/03) |
| Weeks to approval |
1 |
| Comorbidities |
arthritis, BMI of 50 |
| Policy |
Must be medically necessary |
| Comments |
HMSA will approve the RNY fairly easily and quickly. Unfortunately, I wanted the DS. My surgeon did some informal asking and political work to try and get me the DS, but they wouldn't approve it. It's deemed experimental. My surgeon advised me to not apply for the DS as I only have 3 chances for approval. He said if I was refused the DS and appealed that, then was refused again, that would take up 2 of my chances. Then if I asked for the RNY on my 3rd chance and was refused, I'd be out of luck as I'd have used up all 3 chances. He was sure they wouldn't budge, so I went with the RNY request and was approved right away.
I think they are great with their quick RNY approval, though I had to mourn the loss of my DS hopes. My copayment will be about 3 thousand dollars, plus I owe my surgeon 3 thousand directly in addition to what he got from insurance. Plus, my screening tests were not covered - so add on another thousand or so for those - surprise! I just found that out 2 months after surgery, despite trying to clarify with the insurance co. before having any of the tests done. It seems they really can't figure out what is covered until after everything is done - which makes it very hard to figure out costs in advance!
It's even hard to figure out what plan is best in advance, as everyone I talked to only knows the basic party line - like, "that plan covers 90% of surgery costs," but then they can't really tell you what counts as a surgery cost or not! Confusing and I tried for months to get it spelled out - but no go.
I also had some trouble with HMSA because I'd cancelled my primary insurance and was just on my husband's plan. For some reason, despite me sending 2 cancellation letters, someone there kept putting the plan back on, so it messed up my bills getting paid for two months after surgery. I think it's finally getting worked out.
I would have to recommend HMSA as there is only one other insurance co. option in Hawaii (Kaiser) and HMSA is widerspread and offers more as far as I know. |
| Source |
Melanie J |
| Insurer Policy |
Blue Cross/Blue Shield (PPO) |
| Insurer Status | Approved after first letter (07/15/03) |
| Surgery Type |
Laparoscopic Other |
| Pre-Op BMI |
64.6 |
| MD-supervised programs |
4 (70 weeks) |
| Source |
Diane K |
| Insurer Policy |
Blue Cross/Blue Shield (HMSA PPO) |
| Insurer Status | Approved after first letter (10/30/04) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
40.0 |
| Policy |
Must be medically necessary |
| Source |
Susan P |
| Insurer Policy |
Blue Cross/Blue Shield (HMO) |
| Insurer Status | First letter sent - still waiting (07/02/04) |
| Policy |
Must be medically necessary |
| Source |
Hollie Q |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Denied after first letter (08/13/04) |
| Surgery Type |
Laparoscopic Lap Band |
| MD-supervised programs |
1 0 |
| Source |
C T |
| Insurer Policy |
Blue Cross/Blue Shield (HMO) |
| Insurer Status | Approved after first letter (09/14/04) |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Comments |
I was only applying for a Panniculectomy to remove excess skin and flesh. I had no contact with them. My Dr, Dr Katsuji Kubo documented medical necessity and I was approved within a week. They are literally a joy to deal with. |
| Source |
Bill M |
| Champus |
|---|
| Insurer Policy |
Champus (Tricare Prime) |
| Insurer Status | Approved after first letter (08/11/99) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
53.3 |
| Comorbidities |
sleep apenia, arthritus, poly cystic ovarian dease |
| Comments |
great they were so willing to help |
| Source |
Elana Taylor H |
| Cigna |
|---|
| Insurer Policy |
Cigna (POS) |
| Insurer Status | Approved after first letter (02/20/02) |
| Surgery Type |
Open RNY |
| Source |
M M |
| department of va |
|---|
| Insurer Policy |
department of va (n/a) |
| Insurer Status | Denied after first letter (12/03/04) |
| MD-supervised programs |
1 (4 weeks) |
| Source |
Robynne M |
| Hawaii Medical Service Association (HMSA) |
|---|
| Insurer Policy |
Hawaii Medical Service Association (HMSA) |
| Insurer Status | Approved after first letter (06/02/01) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
3 (68 weeks) |
| Comments |
I had no problem getting approval from my insurance co.I didn't even have to talk to them.The doctors office did it all.It only took one letter and was approved in a couple of day's. My insurance company is very member friendly and I feel that they try to do what is best for the member in the long run.I wouldn't ever change to another insurer.I would highly recommed HMSA to anyone.They are fair and honest. |
| Source |
Sandra P |
| Health Alliance |
|---|
| Insurer Policy |
Health Alliance |
| Insurer Status | Approved after first letter (01/07/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
43.3 |
| Comorbidities |
Sleep apnea, fibromyalgia, borderline diabetes |
| Policy |
Must be medically necessary |
| Comments |
I did not experience any delay - insurance company approved within one week. |
| Source |
Cheryl L |
| Insurer Policy |
Health Alliance |
| Insurer Status | Approved after first letter (07/2001) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
47.1 |
| Comorbidities |
hypertension |
| Policy |
Don't know |
| Comments |
I had no problems with UHA. The surgery was approved in about 2 weeks from the first initial letter. |
| Source |
Chanel T |
| HMA |
|---|
| Insurer Policy |
HMA |
| Insurer Status | Approved after first letter (12/06/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
51.0 |
| Comorbidities |
Diabetes, hypertension, acid reflux, high cholestrol, joint pain |
| Policy |
Must be medically necessary |
| Comments |
I had no problems with the insurance company once the surgeon's office submitted the request for approval. |
| Source |
Pat N |
| hmaa |
|---|
| Insurer Policy |
hmaa (????) |
| Insurer Status | Approved |
| Surgery Type |
Laparoscopic RNY |
| Comments |
Not much to say they preapproved my operation
and then denied by exclusion of the policy
and we appealed,now supposely there going
to pay ,not as yet 7/20/99 |
| Source |
Jv V |
| Insurer Policy |
Hmaa (nightmare) |
| Insurer Status | Approved after first letter (08/21/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
6m |
| Comorbidities |
Sleep Apnea Sciaicia,Bad back |
| Policy |
Written exclusion policy |
| Comments |
It was a nightmare.They were no help at all
I fought them every step of the way.
Every thing was an exclusion of the
policy , I finally after getting every
bill back twice wrote a letter to the
company which I will add , approved the
operation in writing months earlier,The
final outcome was 70% was paid for I payed
the rest. |
| Source |
Jewel V |
| Insurer Policy |
HMAA |
| Insurer Status | Approved after first letter (12/15/04) |
| Source |
Don K |
| hmo |
|---|
| Insurer Policy |
hmo (hmsa) |
| Insurer Status | Approved after first letter (12/13/05) |
| Surgery Type |
Laparoscopic Other |
| Weeks to approval |
2 |
| Policy |
Don't know |
| Comments |
Other then the fact that I was approved at 8:30am the morning I was hoping to have surgery in San Francisco and I was still in Hawaii, it was really easy. Everything was submited by my PCP and that's all that I know about. I called them the morning I was hoping to have surgery and found out I was approved, which then of course I had to reschedule, cause I wasn't there. But I think I just did the process wrong. I had a date I was hoping for first and then did all the paperwork. |
| Source |
Jessica S |
| HMSA |
|---|
| Insurer Policy |
HMSA (PPO) |
| Insurer Status | Approved after first letter (04/06/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Comorbidities |
sleep apnea, difficulty breathing |
| Policy |
Must be medically necessary |
| Comments |
I had no difficulty dealing with them, since Dr. Balfour's nurse took care of everything. |
| Source |
Terry B |
| Insurer Policy |
HMSA (Federal Plan) |
| Insurer Status | Approved after first letter (08/23/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
48.4 |
| Comorbidities |
Sleep disturbance, chronic pain, high cholesterol |
| Policy |
Must be medically necessary |
| Comments |
I was very pleased and honestly shocked when I heard they approved
70% coverage. I only applied on a whim
never thinking it would go through. I would definitley reccommend
this company to anyone |
| Source |
Deborah D |
| Insurer Policy |
HMSA (PPO) |
| Insurer Status | Approved after first letter (10/26/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
41.8 |
| Comorbidities |
heart burn, high blood pressure |
| Comments |
I thought that my policy would only cover 70%, but come to find out I am covered at 90%! |
| Source |
Rica V |
| Insurer Policy |
HMSA (Kapiolani Health hawaii) |
| Insurer Status | Approved after first letter (12/11/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| MD-supervised programs |
2 (36 weeks) |
| Comorbidities |
sleep apnea, high blood pressure, osteoarthritis, irregular heart beat |
| Policy |
Don't know |
| Comments |
Dr. lapshies nurse dealt with the insurance, I was approved in 3 days |
| Source |
Maureen N |
| Insurer Policy |
HMSA (PPO) |
| Insurer Status | Approved after first letter (12/98) |
| Surgery Type |
Open Other |
| Weeks to approval |
4 |
| Pre-Op BMI |
46.2 |
| Comments |
HMSA was helpful. This surgery needed to be pre-approved. They have an office just for pre-approvals.
They did not stall. When I called them, they were very helpful and cooperative.
Yes, they respond to persistance.
Hawaii has a prepaid health insurance law and I have recommended this company to others |
| Source |
Dottie C |
| Insurer Policy |
HMSA |
| Insurer Status | Approved after first letter (10/20/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
41.1 |
| Policy |
Must be medically necessary |
| Comments |
I didn't have to deal with the insurance company at all. Dr. Lapschies staff took care of everything. |
| Source |
Kelli S |
| Insurer Policy |
HMSA (PPO) |
| Insurer Status | Approved after first letter (01/21/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
50.6 |
| Comorbidities |
none |
| Policy |
Don't know |
| Comments |
HMSA was very quick in addressing the request for approval. As a matter of fact, it was approved in 2 days from the time it was received. (The delay was with the surgeon's office -- they told me they'd sent it when in fact, they hadn't!) |
| Source |
Joya K |
| Insurer Policy |
HMSA (medical PPO) |
| Insurer Status | Approved after first letter (07/20/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
37.8 |
| MD-supervised programs |
2 (102 weeks) |
| Comorbidities |
High cholestrol, depression, arthritis, migrane headaches, joint pain |
| Policy |
Must be medically necessary |
| Comments |
I was amazed at how quickly I was approved. I think it was because Dr. Lapschies had so much information in his letter, that they did not have to question anymore. |
| Source |
Sarah G |
| Insurer Policy |
HMSA (HPH Plus) |
| Insurer Status | Approved after first letter (09/24/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
67.3 |
| MD-supervised programs |
3 (24 weeks) |
| Source |
Sue K |
| Insurer Policy |
HMSA (BLUE CROSS) |
| Insurer Status | Approved after first letter (05/08/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
40.6 |
| MD-supervised programs |
2 (104 weeks) |
| Source |
Kimberly P |
| Insurer Policy |
HMSA (HPH-Straub) |
| Insurer Status | Approved after first letter (06/10/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
64.7 |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Comments |
I experienced no problems or set backs. They were extremely pleasant when I called to inquire of my status. They also shared with me my covered benefits and that I should not have any out of pockets expenses to be expected. |
| Source |
Theresa K |
| Insurer Policy |
HMSA (HPH) |
| Insurer Status | Approved after first letter (07/09/03) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
41.0 |
| Comorbidities |
Hypertension (controlled by meds); borderline diabetes; elevated cholesterol (controlled by medicati |
| Policy |
Must be medically necessary |
| Comments |
My hospital bill was paid with no problem. I am still trying to get the anesthesiologist and pathology doctors paid. At first the insurance company said these services were not covered, however, now they admit the services are covered and are supposed to have resubmitted these charges for payment. However, it has been a month since the claims were resubmitted and I am still getting bills from the doctors for payment.
8/12/03 - FINALLY, all my bills have been paid by my insurance company. |
| Source |
Sharon S |
| Insurer Policy |
HMSA (James P Byrne) |
| Insurer Status | First letter sent - still waiting (08/18/03) |
| Source |
Linda B |
| Insurer Policy |
HMSA (Federal Plan) |
| Insurer Status | Approved after first letter (Feb. 16, 2007) |
| Surgery Type |
Laparoscopic Vertical Sleeve Gastrectomy |
| Weeks to approval |
1 |
| Comorbidities |
sleep apnea, GERD, hypertension |
| Policy |
Don't know |
| Comments |
I can't believe how fast I was approved! It took exactly one week for Marilyn from Dr. Cirangles office to get the approval. I was thinking that it would be a lot longer than that, and possibly more than one attempt. I was very pleasantly surprised! |
| Source |
Sharon R |
| Insurer Policy |
HMSA (PPO) |
| Insurer Status | Approved after first letter (10/14/03) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
39.5 |
| Policy |
Must be medically necessary |
| Comments |
Doctor's staff takes care of all the hard stuff. They don't seem to stall. I have no qualms suggesting this company (but in Hawai'i, there are not a lot of other choices! |
| Source |
William G |
| Insurer Policy |
HMSA (PPO) |
| Insurer Status | Approved after first letter (10/14/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Comorbidities |
hypertension |
| Policy |
Must be medically necessary |
| Comments |
No problem...the doctor's office did it all. And Doctor Balfour is a preferred provider. They are used to this type of surgery...in Hawaii, we have a lot of BIG people. Several of my husband's friends are in the 400-600+ pound range. |
| Source |
JoAnne G |
| Insurer Policy |
HMSA (PPO) |
| Insurer Status | Approved after first letter (12/3/03) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
1 |
| Comorbidities |
asthma, hypertension, diabetes, PCOD |
| Policy |
Must be medically necessary |
| Comments |
I have had a pleasant experience dealing with HMSA. As soon as all documentation was received they rapidly approved my authorization for surgery. I would recommend that anyone needing this surgery follow all pre-op testing and ensure that all physician records and tests are submitted together. |
| Source |
Jeanne R |
| Insurer Policy |
HMSA |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic Vertical Sleeve Gastrectomy |
| Weeks to approval |
1 |
| Pre-Op BMI |
44.2 |
| Policy |
Don't know |
| Source |
Tina P |
| Insurer Policy |
HMSA |
| Insurer Status | Approved after first letter (03/04/04) |
| Source |
Linda M |
| Insurer Policy |
HMSA (HPH PLUS) |
| Insurer Status | Approved after first letter (04/06/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
GERD, HTN, joint pain, BMI>40 |
| Policy |
Must be medically necessary |
| Comments |
HMSA was wonderful. My PCM sent in the request with all the medical necessity information and within 1 week the surgery was approved. I think that it would have took longer if all the paper work had not been turn in togather as a packet and if medical necessity was not met. |
| Source |
Linda M |
| Insurer Policy |
hmsa (ppo) |
| Insurer Status | Approved after first letter (04/16/04) |
| Surgery Type |
Laparoscopic Vertical Sleeve Gastrectomy |
| Pre-Op BMI |
60.6 |
| Source |
Kim H |
