Lynne1971

Bob, Unfortunately .. I was off from work for a MRSA infection and my FMLA ran out, so I lost my job at the Center. There should be a new secretary working there now, not me ;( I really, really miss the patients! I loved watching their progress and rooting for the new one's to get approved, so it was pretty disappointing for me. Oh well, whaddya do? Lynne :cursing:

Hi .. I used to work for the Program at Genesis, and the reason there is a $25 fee for the seminar is honestly for materials (you get a HUGE packet of information) & Educator time. 99% of all classes are full and there's a waiting list. I actually had an open RNY at Trinity in 1998 and would NEVER recommend (at least at that time) their program. Genesis' program is based on Insurance requirements and it's education and follow-up post surgery is exceptional. Trinity had absolutely NO follow-up care once I had my staples & G-tube removed.

Hi everyone .. I'm new to the Forum! Some of the Genesis patients may recognize me .. my name is Lynne and I was a secretary there. I can offer a little bit of information about the insurance part for ya. #1. Wellmark Federal is completely different than general BC/BS Wellmark. Federal, for the most part, always approves. #2. Wellmark requires a "worksheet" that is filled out by a secretary, and approved by your surgeon that gets submitted to insurance. The information that gets filled out basically is what you offered up on the packet that you filled out that you got at the Education seminar you attended about your diet history. They are looking for structured programs, such as Weight Watchers, Jenny Craig, Nutri-System, etc., and Physician & Dietician assisted programs. Diet and Exercise on your own is included, but IMO doesn't count. #3. Insurance companies have certain co-morbidities that they "count" as needing a surgical intervention - they are: Cardiovascular Disease, Hypertension, Diabetes & sleep Apnea. Although you may have problems with Depression, Asthma, Arthritis, etc. .. insurance doesn't count it. Period. #4. You have to have a BMI of 40+ without co-morbidities to be considered a candidate, or 35+ with one or more of the co-morbids I listed. #5. There are only a handful of insurance companies that do not require a letter from your Primary Care Physician detailing your health & weight loss efforts, Wellmark does require it. Sometimes there isn't any rhyme or reason on why any insurance company may deny (IMO .. Wellmark is notorious for them), but you can ALWAYS appeal. Make sure you gather ALL information you can including all your medical conditions, diet attempts, etc. Even if your denial is upheld, you're NOT sunk!! Call them and demand to speak to the person who upheld your denial ... you just may get approved!