Neighborhood Health Plan MA (NHP)

[braziliangirl 72]

Hello.. I just had my nutritionist apt today and yesterday the visit with the surgeon. Should see the psych in the next couple of days. But, i'm having some insurance fears, as we found this:

NHP covers bariatric surgery for:

Medical necessity for bariatric surgery is established when all of the following criteria are met:

Individuals who are at least 95% of predicted adult stature who are:

1. BMI greater than or equal to 40 (mine is 43)

3. Documented failure of attempts to sustain weight through less intensive, physician supervised methods, such as diet, exercise, behavior modification programs and pharmaceutical interventions ; (in which we are confused if this means that they r going to require a 6 months with supervised program. or if just my medical records, ww attempts, prior weight loss surgery done in 2007 (called Intragastric Ballon - BIB) which didn't worked.) Would those be enough? They already told to expect my surgery to happen by end of march if they approve me...so im very excited and afraid to not get approved?!!! Anyone???

[CaGottaBand 498]

Sounds like you may have to do a supervised diet. Just call your insurance company and ask.

For my insurance my previous ww attempts and a monitored 6 month attempt to lose weight with prescription diet pills did not suffice. I am currently having to do the six month supervised diet with my PCP.

[dylanmiles23 2,198]

Call your insurance company and ask. My doctor's office, BI in Boston, had all the answers for me. I had to change from MassHealth to Network Health and that happened with one call and approved right away. I only had to have a few dietitian visits and have a lot of pre surgery required tests. sleep, upper GI, gall bladder (if you have one-I don't), blood tests and a psyc test. I think that was it. Any more questions I will try to help.

[braziliangirl 72]

Sounds like you may have to do a supervised diet. Just call your insurance company and ask.

For my insurance my previous ww attempts and a monitored 6 month attempt to lose weight with prescription diet pills did not suffice. I am currently having to do the six month supervised diet with my PCP.

I called them, but they said that every case is different, it all will depends of what my surgeon sent to them, and the insurance doctors will review my case.

[braziliangirl 72]

Call your insurance company and ask. My doctor's office' date=' BI in Boston, had all the answers for me. I had to change from MassHealth to Network Health and that happened with one call and approved right away. I only had to have a few dietitian visits and have a lot of pre surgery required tests. sleep, upper GI, gall bladder (if you have one-I don't), blood tests and a psyc test. I think that was it. Any more questions I will try to help.[/quote']

I did already, not much of a help as i described above.

My insurance is towards commonwealth care, type 3 plan.

Hopefully i will not need anymore dietitians visits. I just got off the phone with weightwatchers and they just sent me all my summary, which shows that i did follow their program for over a year.

[braziliangirl 72]

Just got off the phone with my drs assistant, and they booked my surgery for march 21.

They are hoping to get the insurance approval!

Ohh, i cant wait!!!

[Sassybee0317 0]

Just got off the phone with my drs assistant' date=' and they booked my surgery for march 21.

They are hoping to get the insurance approval!

Ohh, i cant wait!!!

[/quote']

I have NHP through my employer and from what I was told by my doctor's office, it was WORK getting NHP to approve my surgery but the process took them less than 3 weeks to put all of my test results and progress from my nutritionist. My last appointment was on January 18th my paperwork was submitted to NHP the following week and I was approved by the first week of February and banded 02/19/13. IJust was surprised at how fast the approval came back. just stay on top of your doctors office and make sure they get all of the necessary documents to NHP and good luck!

[braziliangirl 72]

I have NHP through my employer and from what I was told by my doctor's office' date=' it was WORK getting NHP to approve my surgery but the process took them less than 3 weeks to put all of my test results and progress from my nutritionist. My last appointment was on January 18th my paperwork was submitted to NHP the following week and I was approved by the first week of February and banded 02/19/13. IJust was surprised at how fast the approval came back. just stay on top of your doctors office and make sure they get all of the necessary documents to NHP and good luck![/quote']

I'm so glad to read this!

Tomorrow i start my pre op diet, and knowing this is going to help me a lot with the anxiety..

My surgeon's office sent the paperwork (LOTS of information there) a week ago (march 4), and still waiting to hear back.

I hope they r going to approve and not get back to me asking for a 3months supervised diet.

Would u mind me asking about ur bmi or co-morbities at the time? I'm scared they wont approve because idont have any, but my bmi is 41.8.

Thanks again

[Sassybee0317 0]

I'm so glad to read this!

Tomorrow i start my pre op diet' date=' and knowing this is going to help me a lot with the anxiety..

My surgeon's office sent the paperwork (LOTS of information there) a week ago (march 4), and still waiting to hear back.

I hope they r going to approve and not get back to me asking for a 3months supervised diet.

Would u mind me asking about ur bmi or co-morbities at the time? I'm scared they wont approve because idont have any, but my bmi is 41.8.

Thanks again <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/smile.png' class='bbc_emoticon' alt='' />[/quote']

No problem! My BMI was 43 with no co-morbities. I had lost 60lbs on my own a year prior

[Sassybee0317 0]

I'm so glad to read this!

Tomorrow i start my pre op diet' date=' and knowing this is going to help me a lot with the anxiety..

My surgeon's office sent the paperwork (LOTS of information there) a week ago (march 4), and still waiting to hear back.

I hope they r going to approve and not get back to me asking for a 3months supervised diet.

Would u mind me asking about ur bmi or co-morbities at the time? I'm scared they wont approve because idont have any, but my bmi is 41.8.

Thanks again <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/smile.png' class='bbc_emoticon' alt='' />[/quote']

No problem. My BMI was 43. I had lost 60lbs on my own a year prior. That helped move things along. My first meeting with the surgeon was 11/29/12 and then she left and I met with another surgeon in the practice a few weeks later. He was on top of everything and covered all bases. All of my blood work and appointments were done by 01/18/13 and I attended support groups. The turn around was wayyyyy quicker than I expected. Stay on top of your doctor and good luck!

P.s. where are you having surgery?

[\Mara/ 11]

Hi girls....I was reading your posts, I have BMC /masshealth. ... I hope the insurance help me... nice to see people from MA here!

[braziliangirl 72]

@sassy My surgeon is Dr Adam Glasgow in East Walpole, and the surgery happens in norwood hospital.

How many days exactly took for them to approve you? Xx

[braziliangirl 72]

Hi girls....I was reading your posts' date=' I have BMC /masshealth. ... I hope the insurance help me... nice to see people from MA here![/quote']

Hey! Yeah, so nice to find MA people here

I had BMC(commonwealth care) until last month, but my surgeon said that they require a 6months supervised diet, and i really didnt want that lol, they told me to get NHP as they have worked with them before - and no need for the diet.

I'm hoping this is true, as i wait for their response

Day one of preop diet today - GOD helps me!

[Sassybee0317 0]

@sassy My surgeon is Dr Adam Glasgow in East Walpole' date=' and the surgery happens in norwood hospital.

How many days exactly took for them to approve you? Xx

[/quote']

They typically take 21 days but mine took 12. I looked at my approval letter and it was dated for 02/02/13 and my doc submitted it 01/21/13.

[braziliangirl 72]

They typically take 21 days but mine took 12. I looked at my approval letter and it was dated for 02/02/13 and my doc submitted it 01/21/13.

They told me that they have 14days to give an answer. Omg 21 days would make everything hard.. I only have 10 days now ???–???­???­