Pacificare Insurance

Hi, I'm one month into the required 6-month program called HealthyRoads.  My PCP checked with Pacificare and they require this program.  HealthyRoads has a nutrition consultant by phone call once a week.  They mailed an information booklet on Weight Management and a journal for writing down foods.  Each week she asks a series of questions:  Have you seen the doctor, how many times did you eat red meat, and how did you do with the goal you set for yourself last week.  The goals are as little as getting more water, eating more fiber, etc.  She said after 4 months of this, they will refer me to the surgeon and get that part started I guess. My question is:  After I do all this for 6 months with it going so slow, what else will the insurance company require?  Anybody know before I call them and rile things up!  LOL Thanks for any information anyone has with Pacificare Insurance.          Kathi

hi Kathi, i dont know if you are still looking for information regarding pacificare about a year ago i started my journey to get approved for lap band, i did my psych. evaluation and nutritionist and  got denied, because i had to do a 6 month Healthy roads.i wasnt happy about it, but i went through with it.  We submited everything again to insurance and a week and half later ( it was the longest time every) i got a call that i am approved. So just stick with it,  time will fly and you will get it at the end of your 6 months:)

Hi! Thanks for the response and the encouragement.  I was told by my HealthyRoads counselor that after 4 months we would start the approval process.  I assume that is the psych eval and nutritionist counseling, etc.  I'm already doing most of the things the counselor is having me do.  It's just very hard to have to set a little goal every week.  She wants me to eat more grains and that is interfering with my weight loss.  I've lost about 12 pounds in two months since the referral. Yikes!

I'm fighting this requirement right now. I'll let you know how my fight goes. I already got my surgical referral, my dietician eval, and my psych eval, so all I need is a waiver from this program. I've got doctors working on it, I've got appeals, and if that doesn't work, I'm going to call DMHC and GET them on their case. I'm gonna kick some HMO BUTT and pave the way for others. Woot!