Mclaren heath advantage

[michiganmilkman]

Hello. Anyone have mclaren insurance? If so how was it getting approved

[cinwa]

Rob,

I did a search for members going through McLaren but there doesn't seem to be anyone active at present.  Sorry.  

[michiganmilkman]

Thanks for looking though. My nerves are at wits end waiting for approval.  Lol

[cinwa]

It's normal to feel very uptight and on edge waiting on insurance approval.  I don't think that most insurance company employees understand just how much WLS means to us (unless they've gone through the process).

[kristinwitha_k]

My insurance took SIX WEEKS to approve. I am sure you won't have to wait that long.  But if I can do it, you can do it. Do be sure to let us know when it comes through! 

[michiganmilkman]

Just got told it was denied.  Back to square one

[cinwa]

I'm truly sorry to hear that Rob.  What reason did they give for the denial?  Can you appeal?

[michiganmilkman]

The reason will be in the letter. Yes appealing is a option. Not sure yet if thats the option I want to take. Maybe its gods way of saying dont do it

[Gretta]

What a bummer! I'm so sorry that happened. Keep us posted on the reason.

[michiganmilkman]

What are the chances of a appeal working?

[Readytobeme]

3 hours ago, michiganmilkman said:

Just got told it was denied.  Back to square one

Did you meet all of their requirements as listed in the link below?

http://www.mclarenhealthplan.org/mhcc-member/bariatric-surgery-faq-mhp.aspx

Question: How do I qualify?
Answer:

• Must be 18 years of age or older
• Your doctor has ruled out other reasons that you are over-weight, like hypothyroidism
• 6 months recent attendance at a supervised weight loss program. (Supervised means Weight Watchers, medical weight loss clinic or your doctor)
• BMI 35 or greater with 2 uncontrolled medical conditions such as diabetes, sleep apnea not controlled by C-Pap, high blood pressure not controlled with medication, uncontrolled high cholesterol or severe cardiac-pulmonary disease
• BMI 40 or greater with or without medical conditions
• Must pass a psychological evaluation for bariatric surgery performed by a licensed independent behavioral specialist
• Be evaluated by a contracted multidisciplinary facility. For example: McLaren Bariatric Institute

All of the above information will be sent to McLaren Health Plan for medical necessity review by your doctor.

• If this is approved, an authorization number will be sent to your provider.
• If this is not approved, a denial letter will be sent to you and the provider.

[michiganmilkman]

Just now, Readytobeme said:

Did you meet all of their requirements as listed in the link below?

http://www.mclarenhealthplan.org/mhcc-member/bariatric-surgery-faq-mhp.aspx

Question: How do I qualify?
Answer:

• Must be 18 years of age or older
• Your doctor has ruled out other reasons that you are over-weight, like hypothyroidism
• 6 months recent attendance at a supervised weight loss program. (Supervised means Weight Watchers, medical weight loss clinic or your doctor)
• BMI 35 or greater with 2 uncontrolled medical conditions such as diabetes, sleep apnea not controlled by C-Pap, high blood pressure not controlled with medication, uncontrolled high cholesterol or severe cardiac-pulmonary disease
• BMI 40 or greater with or without medical conditions
• Must pass a psychological evaluation for bariatric surgery performed by a licensed independent behavioral specialist
• Be evaluated by a contracted multidisciplinary facility. For example: McLaren Bariatric Institute

All of the above information will be sent to McLaren Health Plan for medical necessity review by your doctor.

• If this is approved, an authorization number will be sent to your provider.
• If this is not approved, a denial letter will be sent to you and the provider.

Yes I met all the requirements.  Only thing is I had a 8lb weight gain over the 6mo diet. 

[Readytobeme]

Just now, michiganmilkman said:

Yes I met all the requirements.  Only thing is I had a 8lb weight gain over the 6mo diet. 

Most insurance companies that I have read about don't require that you lose weight on the supervised diet. They only require that you are monitored for the 6 months. You may need to wait for the letter or call and ask what the reason for denial was. Maybe something simple that you could easily rectify?

[Readytobeme]

If I were in your shoes, I would appeal and do anything else that I had to in order to get approval. This surgery can be lifesaving and it is just that important to me.

[michiganmilkman]

3 minutes ago, Readytobeme said:

Most insurance companies that I have read about don't require that you lose weight on the supervised diet. They only require that you are monitored for the 6 months. You may need to wait for the letter or call and ask what the reason for denial was. Maybe something simple that you could easily rectify?

I really hope so. Im a dairyfarmer and I kinda had this planned around the seasons and when I could get help in the farm. Just put me in a sour  mood

 

[Readytobeme]

4 minutes ago, michiganmilkman said:

I really hope so. Im a dairyfarmer and I kinda had this planned around the seasons and when I could get help in the farm. Just put me in a sour  mood

 

 

I totally understand. Seriously, looking at your stats and from what you have said, it has to be something small on the criteria you have not met. Maybe you could give them a call or look online if you have online access to your account. I know that it will be hard waiting for the letter to arrive.

[michiganmilkman]

18 minutes ago, Readytobeme said:

Most insurance companies that I have read about don't require that you lose weight on the supervised diet. They only require that you are monitored for the 6 months. You may need to wait for the letter or call and ask what the reason for denial was. Maybe something simple that you could easily rectify?

I really hope so. Im a dairyfarmer and I kinda had this planned around the seasons and when I could get help in the farm. Just put me in a sour  mood

Thank you for the kind words.  

[Readytobeme]

1 hour ago, michiganmilkman said:

I really hope so. Im a dairyfarmer and I kinda had this planned around the seasons and when I could get help in the farm. Just put me in a sour  mood

Thank you for the kind words.  

That's what we are all here for. To support each other when needed and even when it's not. Please do keep us posted. I will keep my fingers crossed for you.

[kristinwitha_k]

Sometimes insurance companies deny over tiny things like a missing piece of paperwork. Unfortunately, they're in the business of trying to not pay our medical bills - sorry to be cynical, but that's the truth of it. Definitely find out why they denied you, and either appeal, or work on fixing whatever criteria you didn't meet. Your program coordinators should be helping you with this. Good luck, and do keep us posted. I'm sorry you're having to deal with this. 

[Gretta]

They're hoping you give up. Don't give up! We're rooting for you!

[Michael_A]

On 11/15/2017 at 12:17 PM, michiganmilkman said:

Just got told it was denied.  Back to square one

Mine was also denied. But, I knew that I qualified in every way, according to their list of requirements.  I called them the next day, and had the reversal the day after that.

I truly think that often times, insurance companies deny EVERYthing initially.

[BurgundyBoy]

7 minutes ago, Michael_A said:

Mine was also denied. But, I knew that I qualified in every way, according to their list of requirements.  I called them the next day, and had the reversal the day after that.

I truly think that often times, insurance companies deny EVERYthing initially.

@michiganmilkman Just call and find out what the issue is. Your BMI is > 40. You do NOT have to lose weight while under supervision, that is malarkey. Honestly this just sounds like a mistake or insurance penny-pinching, you certainly qualify. 

My experience is similar to @Michael_A - some companies pay, their people who review things MORE, or view them as being better, if they deny more procedures. 

[Res Ipsa]

My gastric bypass has changed my life for the better is so many wonderful ways that I cannot imagine my life now without it - so if I was in your shoes I definitely would firmly call them for the denial reason and to ask that the decision be corrected.  

If they do not immediately reverse their denial due to a paperwork error, etc., let us know what they claim is the denial reason and we all will try to help.  And if they will not informally reverse the decision, then you want to appeal.

We are here to support you.  Do not give up.

[michiganmilkman]

I called yesterday morning cause I couldnt wait till I got the letter. The lady that is looking over my case at the insurance company said I need to show steady weight loss for six months. I told her that it was not on the website like that. And she said that it didnt matter. She told me to lose 1 to 2 lbs a week for the next three months and resubmit it with 9 months of data.    Not sure what to do......

[Readytobeme]

1 hour ago, michiganmilkman said:

I called yesterday morning cause I couldnt wait till I got the letter. The lady that is looking over my case at the insurance company said I need to show steady weight loss for six months. I told her that it was not on the website like that. And she said that it didnt matter. She told me to lose 1 to 2 lbs a week for the next three months and resubmit it with 9 months of data.    Not sure what to do......

Do you think that you could lose 4 pounds per month for the next 3? Three months is not a long time to wait for something that will change your life and health drastically. Plus keep in mind that if you are able to lose weight before surgery it will make the surgery that much safer and easier to recover from.

Heck, if you have surgery in 3 months, you will have surgery the same time as I am. Use the 3 months to get your ducks all in a row. There you have my honest opinion.