Harvard Pilgrim Requirements

[NikkiC 37]

Hi Everyone!

I am new to the group. I attended an informational Bariatric seminar the 2nd week of January, and ultimately decided I would like to go forth with the sleeve option. I saw my primary care physician yesterday morning to obtain a referral to see Dr. Jeannine Giovanni – (Bariatric Center of Excellence). I received the referral, and I see Dr. Giovanni on Monday! I am really excited, however, I generally have a little black cloud that rears its ugly head just when things seem promising. I am 5'2", weigh 223lbs, and my BMI is 40.13 (just made it), I am wondering what hoops Harvard is going to make me jump through, is anyone familiar with their requirements regarding showing weight loss efforts, i.e.: weight watchers, supervised nutrition visits, etc. etc. etc. Also, I am wondering if they're going to require me to attempt to lose weight for 3-6 months first before consenting to approve as my insurance provider. Any thoughts? I appreciate any/all comments, I am very new to all of this and have a long road ahead...

Nikki

[MOMW 71]

The Bariatric center and your insurance carrier will have the best answers. I know for myself they used my initial weight when submitting to my insurance for approval. I was borderline too. If you have things like high blood pressure, sleep apenea, your bmi requirement might be less. Sorry can't give you exact info but this was my insurance requirements.

[NikkiC 37]

I don't have any of the above. I was told you needed a BMI of 40 or above, 35 with one of the ailments you mentioned. I have a clean bill of health otherwise...

Thank you for responding! xo

[Babysteppin 165]

Good to see another Bostonian on here! I have Harvard Pilgrim too, and it hasn't been bad at all so far. They don't require a 6 month weight loss program before surgery, and they didn't really check into to my past attempts at losing weight either...well, nothing beyond what my doctor had written in his notes anyways. HP told me as long as I go to a Center of Excellence, the surgery is covered. There's just a whole bunch of appts to go to for the hospital's program, and paperwork that needs to get pushed around first.

Hope pre-op stuff goes well for you, and hang in there! We'll each get there

[rubinsml 11]

Hi Nikki,

I have HP too. I just had my surgey 12/5/12. HP said all I needed was a BMI of 40 or above and go to a center of excellence. My surgeons office said HP was one of the easiest insurances to deal with and gave fast approvals. There were no problems for me getting approved. Good luck!

Michelle

[NikkiC 37]

Babysteppin and Michelle, thank you so very much for your comments! I can't wait for my appointment on Monday, going to do all I can to get everything done. With you both having HP, I am curious as to how long it took for the full process, meaning your very first appointment to the actual surgery (ex. 2 months, 4 months, etc.)

[Babysteppin 165]

I haven't actually had mine submitted to HP yet b/c I'm still working on all the appts and stuff. I've been in the whole process since Aug, but that's prob because I've taken my time.(since I was sort of a chicken until now.) :ph34r: Hoping it'll go quickly in the end though!

But I hear some of the wait has to do with how good the doctor's patient coordinator is too...like if he/she follows up on your claim regularly or not, and if he/she puts all of the administrative stuff together quickly. If it's going slowly, it's worth poking the insurance company and the coordinator then I guess.

[rubinsml 11]

HI NikkiC,

I had my first appt 9/19/12 and had my surgery on 12/5/12. I did have to lose 15lbs before my surgeon would book the surgery (% of excess wgt), which I did. This was a requirement of my surgeon and not HP.

Michelle

[Bethzy143 164]

Hii i was reading through your posts and i was wondering i any of you had a copay to pay with Harvard Pilgrim i have the same insurance and i have called them they did tell me there was a $1000 copay but they rest is covered 100% now my mother-in-law though has the same insurance and she keeps telling me she has no copay which seems kinda weird 2 me :/

[NikkiC 37]

I received an 80.00 copay bill, otherwise, HP paid for everything, including my own private hospital room.

[Bethzy143 164]

I received an 80.00 copay bill' date=' otherwise, HP paid for everything, including my own private hospital room.[/quote']

Really? Thats awesome hopefully it's like that for us i called the insurance again on Monday and was told yes there is a $1000 copay for hospital admission the rest will be covered but our patient coordinator told me that it is paid after surgery and payment plans can be made for it so thats a good thing

[michelle4873 113]

I have HP and was told I would have 250 copay, I never received a bill! They were by far easiest insurance to deal with, I was submitted on a Friday approved on a Monday!

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[Bethzy143 164]

I have HP and was told I would have 250 copay' date=' I never received a bill! They were by far easiest insurance to deal with, I was submitted on a Friday approved on a Monday!

Sent from my iPhone using VST[/quote']

I was told HP is one of the best insurances 2 deal with for bariatric surgery i start going in for my appointments on the 25th of this month i feel its taking for ever =) if you don't mind me asking how long was your process from start till surgery date i'm guessing it will be around 3 to 4 months? I will be doing my surgery in Boston

[michelle4873 113]

I started January 8th had to do a sleep study and egd and 1 mth of meetings on Monday with the bariatric psychologist group meetings and had my surgery April 26th, and had to lose 25lbs pre op as part of my requirement at Lahey

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[Bethzy143 164]

I started January 8th had to do a sleep study and egd and 1 mth of meetings on Monday with the bariatric psychologist group meetings and had my surgery April 26th' date=' and had to lose 25lbs pre op as part of my requirement at Lahey

Sent from my iPhone using VST[/quote']

Yeah i kinda figured it would be about a 3 to 4 month process if all goes well, i was told we would be asked to loose 10-15 lbs. so thats not bad and i'm guessing they do a sleep study on everyone from the looks of it. How are you doing since you've had your surgery? Is it what you expected? My mother in-law and i are both doing this together we figured we would support each other in the process she is a few appointments ahead of me so she'll be having her surgery more or less a month before me.