Question:
Please tell me about your PPO insurance approval story.
If you have PPO, I am curious to hear about how quickly you got approved, which PPO, what your comorbities were, how much you weighed when you started, where you went, basically, as much as you can tell me. THANKS! — Mary B. (posted on November 4, 1999)
November 3, 1999
Hi Mary. I have PHCS, Allmerica, which is a PPO. For once, I was glad to
have them. Being a PPO, all I had to do was find a surgeon who was a
participating member, and make an appointment. I did that, with several
doctors, made my decision which one I wanted, and got my approval within
several weeks. It was super-easy, no referrals or anything. I started at
300 pounds, I'm now 231 after 14 weeks (been on a plateau for 2 weeks now
which I just broke yesterday)and I feel great! My sleep apnea is gone as
well as my snoring, I can breathe much easier, my feet and lower legs are
no longer swollen, no more headaches, and I had a skin condition, urticaria
pigmentosa (chronic hives that never go away) which has improved
dramatically! My blood pressure is down too. I feel so good!
— Jaye C.
November 3, 1999
I have Health Comp. I had to precertify..by seeing a Psychologist, a
Cardiologist, and an Endocrinologist. I was approved for surgery in 10
weeks. InterPlan (does precertification) was very helpful. I appreciate
their thoroughness. Jeannette
— Jeannette S.
November 4, 1999
Mary, my PPO is First Health and I was approved over the phone on the first
call. My co-morbids are hbp,incontinencem,occular
hypertension,degenerative disc desease, bulging disc, heel spurs, etc. I am
having the Fobi pouch, with Dr. Oscar Lirio in Schenectady, New York.
Rosie, 255lbs. Surgery 2-2-00 Hope this helps!
— Rose B.
November 4, 1999
I have BC/BS of IL PPO. I started in May with a visit to my pcp who
referred me to a surgeon for my initial consult. That appt. was June 1.
The surgeon sent me for a psych evaluation stating that my insurance would
require it eventually (I was lucky and got right in on June 7). By mid
July everything had been sent to bc/bs twice - they never received the
first mailing. August 6 I received my first denial. The pcp & surgeon
both sent appeal letters along with mine and early September I received a
verbal denial. Sept. 13 I copied all my correspondence and sent it to the
IL Dept of Ins. October 25 I received a letter from the Dept of Ins. that
bc/bs would approve my surgery - I still have not actually received it in
writing from bc/bs but I know it is coming. It's a long answer, but it was
a long process
Mary P [email protected]
— Mary P.
November 4, 1999
Sorry - the rest of the story LOL
I'm 5'2" 298 BMI 54
co-morbidities include incontinence, joint pain, foot pain, strong
suspicion of gall stones & sleep apnea (both now confirmed)
— Mary P.
November 4, 1999
Hi. My story is a bit different. I have United Health Care PPO, but it is a
self-funded plan. In other words, my employer is large enough to fund the
plan, and they engage United to administer it. I was 5'6", 250 lbs,
BMI 41, with terrible arthritis, mild sleep apnea, stress incontinence and
depression. I was denied by United PPO immediately. At that point I talked
with my employers and told them the situation. I told them that I needed
this surgery and that we had a couple of options. I could continue through
the process with Unted, appealing the denial with legal help, or the
employers could override United's denial and direct them to cover the
surgery. My employers immediately agreed to the latter. They called United
right then, faxed them a directive to cover the surgery "out of
contract," and two days letter I received an approval letter. I am
grateful to my employers for moving so quickly and being my advocate.
I had an open RNY on September 10, 1999, with Dr. RoseMarie Jones of Indy.
I'm down 49 pounds after 9 weeks --- no sleep apnea, arthritis pain is much
less, I'm feeling great! Whatever it takes... it's worth it! Good luck.
— [Deactivated Member]
November 4, 1999
I have BCBS PPO in Texas. I sent my claim in on Aug 19th. I called 3 weeks
later and they said they did not have it. The doctor resent it. On
September 3rd it went to the board. I called every week asking the
status. They would only say that it went to the board and had no idea when
it
would be back. I quit calling on October 4th. It called back on
October 27th. They said that it had been approved on October 5th. I called
the
provider and they said that they had not received anything. I call
BCBS back asking to fax the letter of approval again to the provider and to
me.
Next day, nothing. I called again. They said they would fax it
again. I was sick the next day, so I did not call back until Nov 1st. They
said that
they had faxed it but could not find a confirmation, but would fax
again. Called next day, they said that the letter had just been typed up,
was on
the desk and they would fax it today. Called next day, they said
that they could not find the letter on the system and that they would have
to type it
up. I told them that I was tired of the run around. They finally
found the letter and it was faxed to the both of us. I am now scheduled for
VBG surgery by Dr Harberg at Park Plaza hospital in Houston on Jan 17th.
— texasweb
November 5, 1999
Mary,
I have a PPO in Michigan. Surprisingly i was approved after a three month
wait. The process took a long time but they never asked for any additional
info or called me with any embarrassing requests. So i can say that
dealing with my PPO, which is MLBMA, was a slow but good experience.
I hope your experience is the same.
Diana
— Diana G.
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