Question:
Pay percentage?

I have Unicare Platinum PPO out of Mississippi. My in-network percentage is 90/10 and out of network 70/30. I wanted to know how well do they pay for an open RNY if anyone has used them. My surgeon's office faxed a copy of his letter, my diet history, as well as a letter of clearance/my diagnoses from my PCP to Unicare. This was done on Thursday morning and a Unicare representative called the surgeon's office right back and asked a few questions about me and said it would be turned into medical management for approval. I would like to get a jump on them, but I don't want to get an appt. for a psyche eval if I don't need one. Tomorrow I am going to have my PCP's office fax a copy of my recent (2 weeks ago) TSH to them also. How long do you think it will take?    — Sonya P. (posted on June 1, 2003)

June 1, 2003
I wouldn't bother with your TSH as it won't factor into approval or not. If you are not already under care with a psychiatrist or psychologist then it may very well take you a month or two to get an appointment, so you might want to make the appointment and can always cancel if you don't need it. It sounds like things are goin okay so far. They didn't just chuck it in the garbage and say no, they called ad asked additional questions. To me that is a good sign that at least they are really looking at it. I hope everything goes great and you get surgery soon.
   — zoedogcbr

June 1, 2003
I heard from them this morning. They want a detailed diet history, TSH level, and psyche evaluation. Looks like it'll be the end of the year before I get this done.
   — Sonya P.