Caresouce denied,what now???

was just wondering if anyone has had any trouble with Caresource insurance?? I had my first visit to the wellness center in Springboro Ohio yesterday and was more or less told it was A waste of time...That I came no where close to what Caresource considered LIfe threatening...I have asthema,high blood pressure,GERD,artherites in both knees and can bearly walk,family history of heart attacks and strokes.I am on 1 med.per illness,except the artherites and asthema and for them I take 2-3 meds.I had spent 1 year researching this,and 6 months getting all paper work and dr.visits and was told it was a waste of time.Caresource I guess says if it is not LIFE THREATENING,they will not approve it....Not to mention,My PCP wrote a letter saying that all my health problems were UNDER CONTROL with meds.....any one have this to deal with and what did you do? I had the 9 months diet under dr.care,and everything...I was worried about the 9 months of diet,but I had that covered more then once,I was floored,cried all night,kept the whole house up most of the night....anything will help....                  Thanks ahead of time for any responses...                                             Mary

Is self pay an option?  Have you considered lapband?  I have seen lapband advertised here for 7300.00--I was self pay and paid 13,950.....There are finance companies that will cover the expense...National City is one, but I know there are others...How about a home refinance or an advance against a 401K or credit cards--Don't give up--I took the attitude that I WAS worth the price of a used mini van....Best of Luck...Theresa

Have you called Caresource yourself to see what they are saying??? It could be that it's just that the Wellness center in Springboro doesn't have luck with Caresource.  There are a lot of good doc in Kettering and Miami Valley you might want to call around and see if any of them take Caresource.  Here's the OHIO of doctors that have registered with OH http://www.obesityhelp.com/morbidobesity/bariatric+surgeons+ in+ohio.html MORE OHIO doctors not registered with OH http://www.obesityhelp.com/morbidobesity/nonsponsoring+baria tric+surgeons+in+ohio.html I would also talk to your PCP and TELL HIM how you need the letter written. Yes you are under control but these health problems could almost be GONE with WLS. IF he doesn't want to do that I'd also be looking for a new PCP. Remember you are the boss these doctors are working for you and right now they are not. You might want to look around some more.  Good Luck.  Robin

Yes,I will be in touch w/ my PCP tomorrow...and I may check out Kettering,MVH is where the wellness center is going through...maybe it just wasn't a good day for me..I don't know,But I will keep trying...And Thanks...

Mary, I called the finacial women yesterday after your post cuz I was freaking out, thinking Caresource never pays. She said they do pay for a lot of people but they are sticklers on having a complete nine month diet attempt under a doctors care and making it sure its medically neccessary. Im good with my 9 month diet but scared about having no health problems. So just try, thats what Im doing- shes sending everything next week, and they usually make a decision within two weeks. Oh, also she said it has to be a center of excellence(whatever that means). Good luck!, Amy

Amy...That's great...I will keep trying...I don't know what the story is or was behind the 30 being turned down,but I do have Artherites in both knees so bad that it is just bone on bone and I have other things going on,I think my letter from the dr. is one of my biggest things that was against me,why she said all my health prblems were under contorl with my meds.I will never know...I have taken every thing for the pain in my knees w/no releif...now taking Darvocets when I just can not take the pain any more...and that is a big deal for me,I don't do good with anything that say's" it may cause drozziness"...I am out like a light....But it is not under now way under control...so I will keep trying.and you do the same...did you say what hospital you were going through?I may try another....Thanks...and keep in touch,Mary

Hey, Mary, I'm going through the Cleveland Clinic. It's a center of excellence and I heard great things about their program. I just am praying they can get me approved. I have heard that sometimes you have to appeal several times.:(  I'll appeal as many times as it takes. I can't go on another diet program, but I have to loose weight. I would change doctors if I was you. My doctor wrote stuff like, high BMI is so dangerous, small children who need a mother ect. Your doctor wrote something that doesnt help you at all!   Amy

I agree.  Contact your insurance company directly and let them tell you what the requirement is.  I cannot imagine that you would not qualify.  You have a number of co-morbidities and a high BMI.  Can you change PCPs?  Some are more WLS friendly than others.  If there is a wellness center at the valley, make an appointment and talk to them.  The Premier Bariatric Center in MVH is an excellent WLS program.  They are a Center of Excellence.

Good luck in your quest.  Don't quit until you get it.  It is worth the fight!

Caroline