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I work for Amerigroup and I process a lot of claims for WLS. From everything I have seen it seems that you have to do 6 months nutrition counseling and all the other standard tests. It also depends on what state you live in because each state has it own plans and rules.
I thought they changed it to 3 months? But thats just what they told me over the phone. I'm hoping to switch to Health Plan of Nevada since they are easier to deal with.
I work for Amerigroup and I process a lot of claims for WLS. From everything I have seen it seems that you have to do 6 months nutrition counseling and all the other standard tests. It also depends on what state you live in because each state has it own plans and rules.
I also have UHC. I got online and searched our benefits. I also needed a 6 mth supervised diet. I began seeing my pcp for 6 mth, every month on time. I googled meds that help with weight loss, then searched my benefits in through express scripts to find out the cost. Once we decided on a med (topomax) I wrote down everything I put in my mouth and how many calories I was eating. I found my surgeon at Cleveland Clinic and began the process. When I began the process I was already done with my supervised diet. Good luck! It's a lot of work :(
Ive had to do all this before. It's quite the pain in the butt. I had a different ins co also. I googled how to write an insurance appeal letter, got every type of record from every dr I have ever seen, a letter from my pcp and mailed it in with delivery signature confirmation. Make sure you do that because they will say they never received it. After they got it, I have them 5 business days, then I grabbed my copies and called them every other day until they approved it! Unfortunetly I had a bad experience with the band, after all that trouble, and had to have it taken out a month after getting it :(. That was in 2008 and since then my health had declined, I have diabetes and am in the process of RNY. It's a long hard process for an appeal but stay on them!!! That's the key! Good luck!!
You're welcome feel free to look up my facebook surgical page https://m.facebook.com/Megans-roux-en-y-570321976511408/ and if you have any questions about iehp or anything let me know, I also know several others who got approved by iehp. :)
I appreciate you taking the time out and answering all of my questions! You have been super helpful! Fingers crossed everything goes through!! Congrats on your surgery as well!
Check online iehp website you can see the minute they make a decision on referral. Yes the surgeon will order everything else. You will go to a seminar then have a consultation, at the consultation they'll talk about your surgery options and give you a list of clearances you must complete mine was an endoscopy, chest xray, galbladder ultrasound, psych eval, ekg, and you need a medical clearance from your pcp separate from the letter of necessity. Depending on your health you might need different clearances but once you finish they'll submit to iehp for surgery and you'll get an answer within 5 business days, I got mine the next business day. The surgeons office knows how to deal with iehp, the biggest hurdle is getting to the surgeon after that it's easy!
Yeah , I haven't been in CA either. I have completed the whole 6 month with a pcp diet already.. she put in for the referral today along with a letter of necessity. Hopefully because my bmi is 54 they just approve it. I hope it doesn't take too long for an answer either. Another thing... The surgeon is the one who orders the other test correct?
I did and I hadn't been in california the last 5 years. Try to get your medical records if you can get 1 weight record per year it will work just know you have to do a pcp assisted weight loss attempt before you can see a surgeon you have to see your pcp or join weigh****chers and go no less than once per calendar month for 6 months
I just had my surgery Tuesday morning, you can get iehp to pay but you have to fight for it.
Did you have to show 5 years of being over weight for IEHP? I have been over weight my whole adult life pretty much but hardly had insurance to go to the doctor so I'm not sure I have records going back 5 years.
Hockeymom87 · 0 replies · 857 views
