Pacificare HMO - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

chyoung · 01-24-2008, 05:37 PM

I was just denied with Pacificare for a consult. How do you fight Pacificare to have them approve this surgery?! I am also diabetic. I just heard that with this surgery, you also get rid of the diabetes. I am new here, help!

Charlotte

frances · 01-26-2008, 08:35 PM

Quote:

Originally Posted by chyoung

I was just denied with Pacificare for a consult. How do you fight Pacificare to have them approve this surgery?! I am also diabetic. I just heard that with this surgery, you also get rid of the diabetes. I am new here, help!

Charlotte

I had Pacificare when I had mine done four years ago. I believe how I got the approval was to look in the handbook for coverages and they had GBS listed as only being covered if you met the National Institue of Health (NIH) guidelines, which were BMI over 40, or BMI 35 and up with a comorbidity - which I believe diabetes is. Check that out and see if that is still the case.

Ruca · 01-28-2008, 06:20 AM

It would be beneficial to know what state you live in.

chyoung · 01-28-2008, 02:35 PM

Thanks Francis. I will for sure look. I will be seeing my primary this Friday and discuss with her what I need to do and go from here.

Charlotte

Ruca · 01-28-2008, 10:33 PM

This is kinda why Ive given up trying to help people. Seems they pick and choose what info to volunteer when asking for broad form help. I have a lot of experience with the Pacificare HMO.

If you already have all the answers you are seeking disregard. Otherwise, what state do you live in?

mrscmom2b · 06-19-2008, 10:42 AM

Going to see Dr.Jabro on July 31st.....I have pacificare ins. I'm over 300lbs, but no comorbidities really, I guess that is unfortunate, although I am just waiting for the day they tell me I have diabetes. So done with being fat, looking for some support and some insight as how to deal with doc and ins. Thanks.

LyndasRoom · 06-19-2008, 05:41 PM

Pacificare covered my surgery 2 years ago. They did not approve the consult until I had 6 months supervised weight loss program with my primary care doctor-and then the doctor had to request the consult. Like Ruca said, she's got TONS of insurance info and experience with the Pacificare HMO. It would help her to answer your question if you said what STATE you live in.

mrscmom2b · 06-19-2008, 10:19 PM

im in california.....im so worried!

doxielover · 06-20-2008, 07:44 PM

You shouldn't have any problem being approved for the surgery in California since you weigh 300 pounds I assume your BMI is over 40 AND please remember that if the insurance company tries to put you on the six month diet you can appeal and that decision will be overturned by the California Department of Managed Care! Just make sure and read your insurance certificate and find out if the surgery is offered for medical necessities or excluded completely. Good Luck~

mrscmom2b · 06-20-2008, 10:37 PM

thanks for the info! i will try and get the insurance info, congrats on your surgery! did i read the dates right? are you just a few days post op? how are you feeling

i am so happy for you, you must be so happy. good luck to you, and take it easy.