Priority Health question

I have a friend who is interested in either RNY or lap band. Does anyone out there know what the qualifications are for Priority Health? I saw somewhere that BMI has to be 50, but wondering if that's changed. Also, does Priority Health require a referral from a primary care doctor? This friend's doctor isn't supportive of WLS. Marie

Priority Health's biggest obstacle is the 6 months of weight loss classes at their approved clinics. And yes they require a physicians referral, personally I'd tell my primary that I'd hate to change primaries, but if I can't get a referral I would change. And the BMI is tiered with co-morbid conditions. I think they start at 35 bmi with several co morbid conditions, then over 50 bmi with minimal or zero co morbid conditions. My tip is to call Priority and request they mail you their requirements. I did that after my first attempt for approval was denied because Priority Health changed their standards. That way I was armed and ready for a fight if denied again. Needless to say, as soon as I finished my 6 mo of classes (which sucked) I was approved. Renee RYN Dec 11 2006

I was approved first go around with priority health. I was very lucky in a sense. I had only one comorbidity and that was my OSA. But my BMI was 60. Just depends with them but since I do billing and prior auths often with then and other items I know what to send. I sent a letter, a five page letter in fact. I poured my heart out as to why I needed the s urgery what I gain what they would gain. I also sent them records, like my weigh****cher records, my curvers exercise schedule and progress that went down hill even though I was still attending and trying. They received it all and gave me an approval. If I can be of any please email me at [email protected] and I will more than happy to help you with anything I can. Melody