Theresa23

I am going through the approval process with my surgeons office, and I have a question about my insurance. I have UPMC for you in Lehigh County, PA. I am getting conflicting information from call center reps about the requirements. Specifically the medically supervised diet, I have been told 3 months, 6 months and no diet is required. So, I found the Policy and Procedure manual on UPMC's website for my policy. It states that with a bmi over 40 (mine is 43) I need to meet one of the following requirements either have a co-morbidity, or have 6 months of doctor supervised weight loss. I have moderate to severe sleep apnea, which is a listed co-morbidity. So in my mind I meet the qualifications. However when I called back with the policy and procedure manual I was told that the 6 month weight loss program was a requirement of my surgeons group. This is not the case, I spoke to the nurse at my surgeons office and was told that they don't set those requirements. I just had my 3 month weigh-in and we decided to submit for instance yesterday. If I am denied will I be able to speak to UPMC's medical department that makes the decision? How long should I expect to wait for a decision? Any other advice or information would be appreciated! Thanks

Congratulations ecburger on deciding to have wls, it was the best decision of my life no regrets! Here is the link, if it doesn't work let me know I can scan and email the document to you. If you need any help understanding the insurance language let me know also willing to help. https://www.upmchealthplan.com/docs/providers/PandP/MP.040.pdf

Okay, well I will see you there then.

That's great hope everything goes well fingers crossed! Do you attend the monthly support groups? I have been to everyone but the one I missed the one in August.

Glad I could give you some hope! I have UPMC and I live in Allentown, Pennsylvania. Good luck hopefully your insurance approved you soon.

I live in Allentown, PA. I am having surgery with Dr. Holland at Sacred Heart Hospital. I was just approved by insurance, and will have surgery by the end of September. Where are you in the process?

My doctors group submitted to insurance a week ago, I asked them to submit before they thought I would get approved. I was told by the surgeons group, and several insurance reps that I needed to do a 6 month program, but I only did 3 and I was approved! Surgery is scheduled for 9/29. So excited!

Just in case anyone was wondering the outcome was I was APPROVED! My doctors office even thought I was going to be denied, and be forced to do another 3 months of weigh ins, but I was right about the policy and procedure manual.

I live in Allentown, PA and am having surgery at Sacred Heart Hospital with Dr. Holland on December 21, 2015. I would like to meet and talk with some locals as well.

My insurance company customer representatives are clueless when it comes to what the criteria is for wls. I have been told by multiple reps different requirements. Instead I requested a copy of the policy and procedure manual. I also requested a case manager be assigned by my insurance company, so I have one person dedicated to researching any questions I might have. Lastly you can express your concern/confusion with your surgeons office and request that they contact your insurance to clarify. Hope this helps. Good luck!