Priority Health Anyone?????

Hey Michiganders, I'm just starting my possible WLS journey and wondered if anyone out there has Priority Health and what your experience was with them?  If you got approval, how long did it take?  Any info you could give me is greatly appreciated.  I say possible as I'm not sure if PH will approve me, though you see my BMI is definitely high and I do have co-morbs to go with it.  Either way, about six weeks ago I got myself "in order" by starting a food journal, keeping track of calories, exercising (well as much as I can - currently having hip issues), and weighing myself weekly.  I knew whatever happened, that I had to start doing the work to get myself healthy.  The great news is I've lost 20lbs in this time. I had my visit with my PCP yesterday to discuss WLS and her nurse mentioned PH was one of the toughest to get an approval from.  My PCP warned me this might be a lengthy process, so I'm guessing PH isn't fun to deal with on this issue. Thanks for any info you can give me. Melinda

Follow the priority rules and you should have your approval for surgery.   They are not that hard to deal with if you have your referal from the pcp and the supervised weight loss attempts and meet requirments then you should be able to have surgery.  Just be prepared that you will have a 1000.00 copay for bariatric surgery.   Tricia

I do hope you have better luck than I did with p/h. I was denied in Oct o6. I was crushed. My husband now has b/c and I am on the journey again. Have appt with surgeon in July.  PH is very difficult to work with. (my doctor said she cringes when someone has priority health).  They are known to fight people every step of the way. Keep your chin up and appeal though if they denie you. You have that right...  Good luck to you.

Good luck with P.H. most people are denied time and time again from what I have heard, sad to hear but true. They just find the best program with the best repution and pay cash and move forward. I have heard of people paying thousand of dollars in dieting plans for PH and still no approval.   So.... good luck is all I can say but if you want WLS get ready to right the CHECK !!

Melinda, You have to follow what they say. Jump their hoops, run their hurdles.  I was approved with no problems.  You have to open to them, give them everything you have.  Dig deep inside you and show how much you want/need this to be healthy again.  My dr was so helpful. He helped me but he also was very up front and honest with me saying Melody, I don't want you to get your hopes up I have far more denials with PH then I have get approved.  Especially the first time. Needless to say, I was approved the first time and it has been the best thing to happen to me.  You will have to go through many tests for them but be patient and take it one day at a time. From the date I decided to have the surgery to my date I believe it was nearly a year. Not bad from what I am told though.   Advice: Sit down and write every diet you have tried.  Be as honest as you can be. I was not able to remember dates that were exact but I gave them year in which I did them. I did find in my records tracking charts that I had kept, such as Weigh****cher charts and Jenny Craig.  I also went to Curves and had them make copies of my charts from my progress with them.  I sent this in with my Prior Auth along with a long letter that I wrote from my heart espressing my concern to be around for my then 15 year old son.  This letter truly came from my heart. I told them our family history, cousin that has had the surgery, anything and eveyrthing I could think of I put in this letter. Even if I didn't think it would be of any worth to them, they might find it to be a critical piece even if I didn't.   You are more than welcome to email me at [email protected] if you wouldlike to ask me any thing further.   Good luck with your journey! Melody

Thanks everyone for replying, it does help to know what I'm in for.  My PCP warned me it could be a year, so we have already set up another appointment so she can help track my diet/exercise for the insurance company.  The office also called in a referral to a surgeon, so I'm just waiting to hear back about that.   Before really contemplating this surgery I told myself that I needed to get healthy.  Sooo, since mid May I have been keeping a food journal, tracking my daily calorie intake, exercising as much as I can (though currently out of action d/t hip problem) and tracking this also, and weighing myself weekly.  My PCP was so impressed with the spreadsheets I gave her and very supportive about my progress so far.  I know that even if I do get surgery, I have to change the way I eat so I figure I'm a little ahead of the game.  AND if I'm not approved, then God has a different path for me to take.  I do know if denied I would appeal. As for the insurance company, I have already downloaded their Obesity Surgery approval policy so at least I know what I need to do to get approved.  Melody thanks for the advice, it really helps.