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Who might cover bariatric surgery in Wisconsin?

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72 records starting with P

“P”: 1   2   >>

P Plus
Insurer Policy P Plus ( hmo)
Insurer StatusApproved after 2nd appeal letter (05/09/06)
Surgery Type Laparoscopic Lap Band
Pre-Op BMI 40.6
Comorbidities GERD, Depression, Hypercholesterolemia, Shortness of breath, NAFLD with fibrosis
Source Brandie A
Pacific Life
Insurer Policy Pacific Life
Insurer StatusApproved after first letter (08/08/04)
Weeks to approval 4
Comorbidities ? Asthma occasionally, family history of heart probs
Policy Don't know
Comments No problems, I was very lucky
Source Michelle T
Insurer Policy Pacific Life (PPO)
Insurer StatusApproved after first letter (12/15/04)
Weeks to approval 1
Comorbidities suspected sleep apnea and diabetes
Policy Must be medically necessary
Comments They responded quickly to pre-approval. My policy states that I must be 100+ pounds overweight, OR less than 100 pounds overweight and co-morbidities. Haven't dealt with them yet. Just my doctor's nurse has had contact with them.
Source Joanne G
Pacific Life and Anunity
Insurer Policy Pacific Life and Anunity (PPO)
Insurer StatusApproved after 2nd appeal letter (06/26/05)
Surgery Type Laparoscopic RNY
Source Susan H
Pacificare
Insurer Policy Pacificare (Point of Service)
Insurer StatusApproved after 2nd appeal letter (11/26/99)
Surgery Type Open RNY
Source Lauren W
Insurer Policy Pacificare (State of WI)
Insurer StatusDenied after legal action taken (11-28-00)
Surgery Type Open RNY
MD-supervised programs 2 (28 weeks)
Comorbidities High BP, Type II Diabetes, Gerd, arthritis, sleep apnea, weakened heart
Policy Written exclusion policy
Comments Self Pay, because the lovely State of Wisconsin doesn't want their employees or beneficiaries to have this life saving procedure. We filed a grievance, and went as far as a hearing with the Department of Employee Trust. In the end, we were told that even if it was ruled that CompCare should have paid, they couldn't be forced to! WHAT'S WRONG WITH THIS PICTURE??? HAVE NEW INSURANCE NOW FOR MY RECONSTRUCTION. I now have Humana HMO Premier, and they've approved ALL the reconstruction!
Source Bonnie B
Insurer Policy Pacificare (HMO)
Insurer StatusApproved after first letter (08/05/00)
Surgery Type Open RNY
Weeks to approval 2
Pre-Op BMI 49.9
MD-supervised programs 3 (22 weeks)
Comorbidities arthritis, PCO, acid reflux
Comments Requires a psych eval before they will even consider it. It all went very quickly after that. I called frequently to check on status and was surprised when in 2 weeks it was approved and surgery was set for 2 weeks later!
Source Debb W
Insurer Policy Pacificare
Insurer StatusFirst letter sent - still waiting (10/10/01)
Source Yelonda N
Insurer Policy Pacificare
Insurer StatusFirst letter sent - still waiting (07/18/03)
MD-supervised programs 4 (106 weeks)
Source Treesa M
Insurer Policy Pacificare (federal policy)
Insurer StatusApproved after first letter (11/21/01)
Surgery Type Open RNY
Weeks to approval 1
Pre-Op BMI 41.3
MD-supervised programs 2 (32 weeks)
Comorbidities arthritis, GERD, esophageal ulcer, irritable bowel,
Policy Must be medically necessary
Comments Letter for consult sent and approved within 3 days. Have been very good about other referrals so have an optomistic feeling about this. Will see surgeon July 9. Then will submit letter for surgery approval. It is allowed in my policy if 100# overweight. It has taken 3 months to complete all the preop tests and procedures. The insurance has been very cooperative and helpful throughout. I had 2 denials for coverage of sleep study, but was approved within 1 hour of recieving the correct information. Don't give up if you get a denial. Call the insurer and ask what info they have. Then get them more detailed documentation. We are preparing to mail the information to request surgery approval now. Approved in 5 days! My insurance company has been great to work with. They put up no barriers and when I called to check status, each time I was treated as a welcome call. The processers were all very friendly and helpful. I don't believe rudeness or daily calls are the way to go. Give them reasonable time to process and treat them the way you want to be treated. I called about every 1 - 2 weeks and that was just right to make sure everything was moving forward.
Source Jane W
Insurer Policy Pacificare (OPT)
Insurer StatusDenied after first letter (06/25/01)
MD-supervised programs 2 (48 weeks)
Source Catherine W
Insurer Policy Pacificare
Insurer StatusApproved after first letter (06/24/02)
Surgery Type Laparoscopic RNY
MD-supervised programs 2 (60 weeks)
Source Connie S
Insurer Policy Pacificare
Insurer StatusFirst letter sent - still waiting (07/11/02)
Source Veronica W
Insurer Policy Pacificare (HMO)
Insurer StatusFirst letter sent - still waiting (08/07/02)
Policy Don't know
Comments Unfortunately I can't answer these questions it is to early to tell. But my employer is ok with this seeing I have had six surgeries in the last four years three of which were my knees. As long as I have three days of vacation I can take the short term disability offered through work and my job is gauranteed upon my return. Compcare ( BluexBlueshield) All insurance companies are slow! If they could rid the red tape things would be oh so much easier!
Source Nicki S
Insurer Policy Pacificare (HMO)
Insurer StatusApproved after first letter (08/22/02)
Surgery Type Laparoscopic RNY
Weeks to approval 4
Comorbidities arthritic, diabetic, hypertension, Morbid obesity
Policy Must be medically necessary
Comments We sent in all the information requested including a Mental health eval and was given approval in 28 days. I know Dr. Chua's staff had a lot to do with getting it done so quick and I thank them from the bottom of my heart! However the insurance did specify that they would only approve the Rouex Y procedure and not the lap band. But that was ok because that is what I wanted in the first place!
Source Danielle A
Insurer Policy Pacificare
Insurer Status (03/26/2003)
Surgery Type Laparoscopic RNY
MD-supervised programs 3 (66 weeks)
Comments Froedtert Hospital handled all of the insurance information and submitted all information to the company for approval. All information was received on 3/17/03 and I received my approval letter on 3/26/03 (9 days!!) I was so pleased with the process and would recommend Compcare to others if it is available. They approve the surgery if certain criteria is met, and your surgeons office can assist you in making sure you have all the necessary tests prior to authorization.
Source Traci K
Insurer Policy Pacificare (PPO)
Insurer StatusFirst letter sent - still waiting (11/13/02)
Source Daniela M
Insurer Policy Pacificare (pos)
Insurer StatusApproved after appeal letter (01/01/03)
MD-supervised programs 1 (12 weeks)
Source Billie H
Insurer Policy Pacificare (pos)
Insurer StatusApproved after appeal letter (01/01/03)
Source Billie H
Insurer Policy Pacificare (Point of service)
Insurer StatusApproved after first letter (4-7-03)
Surgery Type Laparoscopic RNY
Weeks to approval 1
Pre-Op BMI 47.7
Comorbidities Sleep apnea,arthritis,HTN,Exertional Dyspnea,DJD, (hip,knees,and back),Acid reflux,Irritable bowel,C
Policy Must be medically necessary
Comments I really don't have anything to recommend, because I really have no problems. I even changed my mind and it only took 6 days to get the apporval for the Lap. RNY.
Source Angel S
Insurer Policy Pacificare (Aurora Family Network)
Insurer StatusApproved after first letter (05/16/03)
Surgery Type Laparoscopic VBG
Pre-Op BMI 52.5
MD-supervised programs 3 (54 weeks)
Comorbidities GERD, arthritis, neuocardiogenic syncope
Policy Must be medically necessary
Comments The men and women in the customer service dept. were wonderful! They were all very friendly,helpful, and understanding. They did not stall at all. They have a policy in place to have an answer within five business after receiving all necessary documents. I received an answer two business days after I faxed my imformation to them. Compcare Blue/Aurora Family Health was awesome. The only dawback is that you can only see Dr. Chua and it takes forever to get an appointment with him.
Source Jeanna
Insurer Policy Pacificare (HMO)
Insurer StatusApproved after first letter (10/7/03)
Surgery Type Laparoscopic RNY
Weeks to approval 2
Pre-Op BMI 51.0
Comorbidities High Blood Pressure, GERD, Poly-cystic Ovarian syndrome, exertional dyspnea
Policy Must be medically necessary
Comments I haven't had any problem getting a list of what they require to approve the surgery. I am currently waiting for approval.
Source Robin S
Insurer Policy Pacificare (HMO)
Insurer StatusApproved after first letter (12/26/03)
Surgery Type Laparoscopic RNY
Comments I had NO problems with this insurance company. At first they couldn't review my file because they were missing a referral form from my Primary care physician. But once they received that, I was approved in about three days. I had no idea that it would be this easy and hassle free. I think the only requirement is that you have a BMI over 40 and the procedure be medically necessary (defined loosely). I have heard that they don't approve Lap Bands because they still consider them experimental but that didn't apply to me because I wanted the RNY. Even the customer service rep that I spoke with was kind and helpful. The only thing that I can complain about is that they don't cover the nutritionist visits Unfortunately I learned this after I had already had two visit and now I'm stuck with a $400 bill - but in my eyes that's a small price to pay for what I'm getting in the end!
Source Miss T
Insurer Policy Pacificare
Insurer StatusApproved after first letter (02/10/04)
Source Jean B
Partners
Insurer Policy Partners
Insurer StatusApproved after first letter (08/06/02)
Surgery Type Open RNY
Pre-Op BMI 53.6
Source AmyJo M
Insurer Policy Partners (Health Partners)
Insurer StatusApproved after first letter (03/31/03)
Surgery Type Open VBG
Weeks to approval 1
Pre-Op BMI 60.2
Comorbidities Sleep Apnea
Policy Must be medically necessary
Comments Perfect in every way! It was a breeze!
Source Sharon C
Insurer Policy Partners (Health Partners Plus)
Insurer StatusApproved after first letter (05/07/03)
Surgery Type Laparoscopic RNY
Weeks to approval 1
Pre-Op BMI 49.1
Comorbidities Arthritis
Policy Must be medically necessary
Comments I was afraid that they would not approve me as one of their criteria was that I had to have been under an M.D. supervised diet for at least 6 months, but they must have accepted the fact that I have been to WW at least 30 times in the last 30 years as evidence that I was not going to lose this weight with diet alone. They actually approved in less than 48 hours, I was thrilled!!
Source Lynn S
PBA
Insurer Policy PBA (PPO)
Insurer StatusApproved after 2nd appeal letter (10/03/05)
Surgery Type Laparoscopic RNY
Weeks to approval 24
Comorbidities GERD, ankle pain and swelling
Policy Must be medically necessary
Comments Dealing with PBA was not a pleasant experience. I was denied twice for things that weren't stated in my plan. I went to the benefits administrator at my employer with the second denial because it was so rediculous. I received my approval letter two weeks later. I spent a total of six months going back and forth with them to get the surgery approved. I feel that they were stalling with the denial letters to either push my date after January 1st so I would have to foot more of the bill or they wanted to see if I would just give up. My advice is be persistent with this company.
Source L N
PBA-Lands End
Insurer Policy PBA-Lands End
Insurer StatusApproved after appeal letter (04/22/2000)
Surgery Type Open RNY
Pre-Op BMI 67.7
MD-supervised programs 1 (4 weeks)
Comorbidities arthritis, hypertension, hypothyroid
Policy Must be medically necessary
Source Nanette T
pcshealth systems
Insurer Policy pcshealth systems (preferred one)
Insurer StatusApproved after first letter (03/08/00)
Source Lori P
Pekin Insurance Co. PPO
Insurer Policy Pekin Insurance Co. PPO
Insurer StatusApproved after first letter (05/15/01)
Surgery Type Open RNY
Weeks to approval 1
Pre-Op BMI 41.4
MD-supervised programs 2 (33 weeks)
Comments My experience with Pekin Insurance Company has been awesome. My PCP faxed paper work to Sharon on a monday. I called tuesday to check on the status of the paperwork and Sharon said she was taking it to her supervisor the following day for approval, and if there was a problem, or they needed more medical records etc, she would not only call my PCP, but would call me as well. Wednesday came and I recieved a message on my answering machine that I was approved! Talk about service!
Source Heidi H
PHCS
Insurer Policy PHCS (BAS)
Insurer StatusFirst letter sent - still waiting (10/05/05)
Source Lesley F
Physicians Plus
Insurer Policy Physicians Plus
Insurer StatusDenied after first letter (12/10/02)
MD-supervised programs 2 (7 weeks)
Source Jessica R
Insurer Policy Physicians Plus (PPO)
Insurer StatusDenied after first letter (01/09/03)
MD-supervised programs 5 (98 weeks)
Policy Written exclusion policy
Comments They refused completely. No letters or negotiation will bring any consideration when dealing with this provider.
Source Debbie S
Insurer Policy physicians plus
Insurer StatusApproved after first letter
Surgery Type Laparoscopic Duodenal Switch
Comorbidities Arthritis, Shortness of breath, Stress incontinence
Source Becky B
Prairie States
Insurer Policy Prairie States (PPO)
Insurer StatusApproved after legal action taken (2/10/03)
Surgery Type Laparoscopic RNY
Pre-Op BMI 50.8
MD-supervised programs 1 (1 weeks)
Comorbidities severe osteoarthritis, spinal stenosis, hypertension
Policy Must be medically necessary
Comments They have gastric bypass covered in their booklet but then want almost impossible documentation. They demand a two-year doctor supervised diet plan with exercise and behavioral modification. I am still in the process of completeing all of the tests the doctors insist on, so at this time a letter for approval has not been sent. 4/03: The insurance company now wants a six-month supervised diet and it has to be within the last two years. They put a time limit on the diet when I could produce three years on the phen-fen diet (did not take the one taken off of the market). They changed the two-year doctor supervised diet when I challenged it and added the six months diet instead. But the nurse told me, if I wanted to, I could go to Jenny Craig's. The only thing, that is not doctor supervised. The surgeon sent a letter of request for surgery, which was promptly turned down. 5/24/03: Filed a complaint with the Wisconsin Insurance Commission. The insurance company has 10 days to respond. I want proof in black-and-white that they have not changed the requirements because of whatever is going on that day or whatever documentation that I can produce. We have went from unlimited time span two-year diet, to a recent (within the last two years) two-year diet, to a six-month diet (within the last two years). I was not told by the insurance company with the initial letter that I had to have the six-month diet, I would have already had three months done and over with. 6/11/03: The insurance company has of yet responded to the demands from the Insurance Commission. Prairie States was refusing to pay for the new surgeon, claimed it was a third opinion, which it was not. Filed another complaint with the Commission and got a letter from Prairie States yesterday letting me know that they would pay Dr. Kumar. Don't know when this will ever end! I would never recommend this company to anyone. As bad as I hate to say, we had better coverage with a HMO, except that they didn't cover anything to do with morbid obesity. 7/27/03: Had RNY surgery one month ago today. After filing a complaint with the Wisconsin Insurance Commission, I received a letter from the WIC, about one month after the complaint, notifying me that the they did not oversee Prairie States because it was self-funded but I had already received a letter from Prairie States letting me know that they had approved the RNY. After they received the initial complaint from the WIC, Prairie States claimed that they had finally received all of the paperwork they needed to approve the surgery but I had only seen the dietician one time. Even though the insurance company is not overseen by the Insurance Commission, it did the trick. Now any more complaints I may have will sent to the Department of Labor or ERISA.
Source Sharon L
Insurer Policy Prairie States
Insurer StatusApproved after first letter (06/29/04)
Surgery Type Laparoscopic RNY
Pre-Op BMI 50.7
Policy Must be medically necessary
Source Marsha S
Insurer Policy Prairie States (PPO)
Insurer StatusApproved after first letter (01/29/05)
Weeks to approval 4
Comorbidities Osteo Arritis, planter faciitis, acid reflux
Policy Must be medically necessary
Comments Ok. typical. They had to wait for the documentaion. yes coordinate and make sure you keep copies of your correspondences.
Source Michele G
Insurer Policy Prairie States (PPO)
Insurer StatusApproved after first letter (5/28/08)
Surgery Type Laparoscopic RNY
Weeks to approval 2
Comorbidities Sleep apnea, Diabetes, Hypercholesterolemia, Shortness of breath, Stress incontinence
Policy Must be medically necessary
Comments It was pretty simple except that they orginally told me that it would only take 3 business days from the day they get the info. But when I called to check on the status they told me that she "might" get to it in 1 month to 3 months from May 12th when they recieved. 2 weeks later I got a call from the surgeon to set up a day for surgery and that I was approved.
Source Kelly C
Prarie States
Insurer Policy Prarie States (WPPN)
Insurer StatusApproved after 2nd appeal letter (03/23/01)
Surgery Type Open RNY
MD-supervised programs 2 (16 weeks)
Policy Must be medically necessary
Comments They are accually just the billing party but, when people ask that's the answer everyone gives. I work for the county and the are self-insured. So, I guess the insurance is Sheboygan County. About Prairie States: They aren't the greatest. Everytime I have anything happen or need to go to the emergency room for anything they always look for ways someone else will have to pay instead of my insurance. Or so it seems to many of us at work. Quite often they call or send letters and ask if each item was an accident and they ALWAYS want more information. Expecting to be rejected. But, this time not going to stop!!!!! 12-1-01 I WON I WON I WON.........WOOOOOOOHOOOOO
Source Deborah D
Insurer Policy Prarie States (PPO)
Insurer StatusApproved after first letter (05/02)
Surgery Type Laparoscopic RNY
Weeks to approval 1
Pre-Op BMI 45.0
Comorbidities degenerative disc disease L4-5
Policy Don't know
Comments I have had no problems with my insurance company. They did no stalling, I did not even need to be overly persistent. I am only 22 years old with no major co-morbidities and a BMI of 44, so I was surprised at how quickly things moved along:) No complaints.
Source Kelly R
Pref One
Insurer Policy Pref One
Insurer StatusApproved after first letter (05/05/04)
Surgery Type Open RNY
Weeks to approval 2
Pre-Op BMI 42.3
Policy Must be medically necessary
Source Stephanie R
Preferred One
Insurer Policy Preferred One
Insurer StatusApproved after first letter (08/20/04)
MD-supervised programs 1 (4 weeks)
Source Connie B
Insurer Policy Preferred ONE
Insurer StatusApproved after first letter (09/7/05)
Surgery Type Laparoscopic RNY
Source Diane P
Preferred One Humana
Insurer Policy Preferred One Humana
Insurer Status
Policy Written exclusion policy
Source Jean L
Prevea
Insurer Policy Prevea (PPO)
Insurer StatusDenied after first letter (10/05/03)
Source Nancy S
Insurer Policy Prevea
Insurer StatusApproved after first letter (03/21/05)
Surgery Type Laparoscopic Lap Band
Policy Must be medically necessary
Source Angela S
Primecare Plus
Insurer Policy Primecare Plus (HMO)
Insurer StatusFirst letter sent - still waiting (12/18/99)
MD-supervised programs 2 (64 weeks)
Source Kim N
princaple life
Insurer Policy princaple life
Insurer StatusFirst letter sent - still waiting (02/05/06)
Comorbidities Arthritis, Hypercholesterolemia, Hypertension, acid reflux, heart burn
Policy Written exclusion policy
Source Kelly N
Principal
Insurer Policy Principal (ppo)
Insurer StatusDenied after first letter (11/02/05)
Source Help4 M

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72 records starting with P

“P”: 1   2   >>