Question:
Any trouble with PHCS Great West?????

Has anyone else had any trouble with PHCS (PPO) Great-West insurance? There is a pre-existing clause, you have to have a psyh evaluation, nutrionlist consult, Endrocrine Study, letter from PCP on letter head stating you have been on a phsycian supervised diet for 12 consecutive months in the last 24 months, if you received any treatment at all for your pre-existing condition 3 months before your coverage started you have to wait 12 months before you will be considered. This just seems like an awefull lot of things to go through. I haven't even had my paperwork submitted yet and I've been at this since Jan 13th. Sorry to complain yall I'm just a little frustrated at this game. I wish I could talk to the same person twice at the insurance company.    — jovialkiki (posted on February 20, 2003)

February 20, 2003
Hi. The company I worked for switched to Great West in January of this year. When my information finally got to the right person, I had an answer in about two days..approved on first try. My suggestion is...If you have all the biggies-letter from your PCP, an endocrinologist visit, a psych eval, and your surgeon's info, including info about your diet history, you should be fine. I had not been on any kind of supervised diet in about a year, but I did have my history and all my other info. As for talking to the same person at One Health plan, if your doctor has sent in the info, you will be assigned a nurse who will look over your info. If you call the member service 800#, you should have an option for pre approval. Go there, see if you can get set up with a nurse and ask for her name and an extension #. If you don't always get her, just ask the rep that you do get if you could be transfered. I hope this doesn't come out like a jumbled mess. If nothing else, go to your plan admin and ask them about their contacts with Great West. Maybe they could help you out. Good luck to you!! Jaime
   — Jaime H.

February 20, 2003
I also had Great West through my husbands insurance, they denied me because I didn't have the 12 months of DR. supervised diet, I have 3 pages of diet, but that wasn't good enough, did everything else they asked psych etc. I ended up changing to my insurance through my work United Health Care, they approved me without any tests and only being with them for 2 weeks. I didn't think that Great West was that great. Mary Ann
   — Mary Ann C.

February 21, 2003
I had Great-West PPO....I had to have my psych eval and nutrition consult as well as a letter from my PCP prior to seeing the surgeon and then they made me come up with a graph of my weight loss for the last 5 years(I went back to 96). I also wrote them a letter explaining what my life style was like(I'm a water exercise instructor at 444lbs)and why I had gaps in my doctor charts(they didn't always weigh me)and I let them know I felt as though the medical community had failed me over and over!!!! I had pages and pages of diets I had tried on my own(diet center, protein power etc) and included them in my graph of weight loss and gain. I did have a dr supervised diet in '96(fen-phen) for about 6 months. Once I had all this they approved me really quick. Good luck
   — Deanna_K

February 23, 2003
I had GreatWest PHCS up until Feb 1 of this year. I began this process under them (back in July '02) and had absolutely no problems getting anything paid. In happened that I went to the surgeon on 1/28/03 and let them know that my insurance was changing to GreatWest One Health Plan as of 2/1/03. All the contact information remained the same because GreatWest is still the administrator of the insurance. I called and got specific names, titles, and contact phone numbers of whom to contact and when. The surgeon sent in the letter on 2/10/03, I was approved on 2/12/03...yes, that's right... 2 days. They had told me it could take up to 8 weeks. I believe that a LOT of insurance issues are because the doctor's staff is unfamiliar with what each insurance company wants/needs. I've always believed they should cover more than what is required. I lucked out that my doctor has a prepared packet that each patient must complete. It covers SOOOO many topics. I wish I had made a copy of it so that I could show others. Other than that, I did absolutely NO other documentation. Of course, one needs to keep in mind that just because people have the same insurance company, it doesn't mean that the same plan is in effect. There are different levels of coverage. Best of luck!
   — Diane S.

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