Wellmark Of Sd

[Wishnto2beskinny 2]

Hello all! I am new to this sight, but have found some awesome topics on here!! I have met with the surgeon finally, and the nurse "thought" that my insurance would require a 6 month diet. I have read where Wellmark has changed in some states and they do not require the 6 month supervised physician diet. I have a supervised diet but it was in 2009 so I think it is too old? I also have all of my weight watchers recpts etc, and gym membership with the wellness key (which is like a physical trainer that we met and changed my programs etc). I have tried every diet.. Body by Vii, HCG, etc. and have all of those as well.. Long story short. Wellmark of Iowa/SD has changed their policy and wil not release any prerequirements for surgery. The website and the customer service reps just say to see your surgeon and if its medically necessary they the surgeon will know what to do.

How frustrating! Before I spend the money for the nut and behavioral health I would like to know if I need to do the 6 month diet. I was told by the hospital that wellmark follows interQual criteria. It states that "one must have continued obesity despite a supervised diet program". So this to me does not say physician supervised.. so will weight watchers work?

Why do they make this so confusing? I actually started seeing my physician at the beginning of April for weight loss consultation and then again May 1st.. (Just so I have 2 months in the process in case I do need the 6 months)

Anyway.. just venting and wanting to see if anyone has Wellmark of SD/IA and what you have had for results.

[cheeri1 3]

Oh, I'm happy to see someone with my same situation - even same Dr. I'm just a month further along in my 6 months of WAITING ! I'm no closer to understanding the mysteries that our ins. imposes! I can't even imagine going thru the 6 months of Dr. visits, then having pre-authorization submitted, only to find they need more info ??!! I cried for two days, when I found out that I had to wait the 6 months AND spend more $ on 6 Dr. visits, to a Dr. that absolutely supports me in having vertical sleeve done. By August, I should be able to submit for authorization. Then it's about two weeks to get authorization back and THEN meet with surg. again and schedule surgery.

Like it doesn't take a lot of thought and study just to get to the point of pursuing this!

Yes, I am frustrated! Trying to be patient... and Very Determined!

[Izzybeff 2]

So you do have to wait the six months? I have Wellmark of IA and when I had researched the surgery last year they had everything pretty marked out on their website. Now I can't find anything. I go to my seminar next week and i'm about 95% sure I want to have the surgery. Will I have to go on a supervised diet for the 6 months? I've been going to the gym for over a year and can get records from them.. will that suffice?

[Wishnto2beskinny 2]

Hello! I am glad to see we have lots in common! I really like Dr. Strand! I believe we will have to have the 6 month diet. But it is all unknown. The time I called and spoke to a supervisor she said that it is all based on case by case situations. (but would not tell me any situations) I have googled the Intraqual Criteria (which Dr. Strands office thought they went by) it states "continued obesity despite supervised diet program <6mo" that is its exact words. (however the form also states it is form 2010, so things may have changed) I guess I don't know how to interrupt the supervised diet program... it does not say physician supervised. SO With all of my recpts and notes from weight watchers, the wellness key from gym, HCG diets from OBGYN (old tho! 2009), and every other diet I have tried, I am hoping that will work. My hopes are NOT real high at this point, just because I think the insurance will deny for any reason. But.. at least I will know for sure if I am spending 6 months dieting/waiting/seeing my physician for a reason. I actually talked to the surgeon back in Sept 2010 and decided I would try dieting on my own again. I lost and of course regained. So I wish I would have seen my family Dr. At that point. Oh well.. They do say that the behavior. psyche consult documentation can take up to 3 weeks... So I am not sure when my case will actually be submitted… but will let you know what it says as soon as I get it back! J

[Wishnto2beskinny 2]

I received my initial consult EOB, and to my surprise it was applied to my deductible as an "out of network" provider. However, I received a "network" savings. I was confused,and of course it was the weekend so I could not talk to anyone. I called Tuesday morning to my insurance company, and yes dr strand is a provider of wellmark, but is not a provider to my specific plan. I even called my insurance prior to going to him, but she said whoever I talked to must not have looked at my plan specifics. So, I called dr. Strands and asked to speak to someone in the insurance department, she asked if my card had a few letters "xqz" or whatever, and it did.. And no, dr strand does not participate with that wellmark plan. I have now spent 550 (initial consult and 300 prepaid $ for the nutrition consult in his office but i am hoping i can either see her still since she is only in their office once a week ( must be somewhere other days??) or she will refund me. I did pay the office and not her specifically tho?? I also asked if anything was submitted as a preauth and it had not, so I told her not to,as I have to change to an in network dr. Ohhh... Insurance is so frustrating sometimes!