Any Marylanders with John Hopkins EHP?

[LisaDM 194]

I am still pre-op. I meet with the surgeon in June. The office coordinator told me that EHP can be a pain to get approval. Anyone else have experience with them? I can't afford self pay so its approval from insurance or no go. Trying to stay positive but also not trying to get over excited. Any advice would be appreciated.

[nonadona 3]

I don't have it but live in MD & have CareFirst BCBS of MD. I went online & read the actual medical policy detailing procedures covered, requirements & guidelines. I meet the criteria but only as of March 25th of this year when it was revised to include sleeve for patients w/BMI<50. (Prior to that date CareFirst MD only approved if BMI was 50 or greater).

[rtaylorel 6]

I'm also from Maryland, I'm going to St Agnes with Dr.Singh.They have the best team in Maryland give him a call...By the way I have Cigna

[gonnadothis 3]

Hi Lisa-

I also have EHP. How are things going? Have you had your first visit? Mine is tomorrow. I'm excited and nervous. Good luck in the process.

[LisaDM 194]

I had my first visit with the surgeon, Dr. Steele yesterday. Went well and they seem positive at this point. I just hope EHP does too! Still many more appts to go through and tests to take. Good luck!

[gonnadothis 3]

I just met with surgeon on 6/10 and they told me the same thing. They were positive but said EHP was tough right now...

[shannyd4 28]

Yup EHP is extremely tough right now... I fought like hell to get approved ... My surgery is on July 3rd now... Finally

[LisaDM 194]

Yup EHP is extremely tough right now... I fought like hell to get approved ... My surgery is on July 3rd now... Finally

What did you have to do, just keep appealing the denial? If you don't mind me asking, what are your stats? Are you over 40 BMI or over 35 with comorbidities?

[Andrea Allen 5]

Hi from MD my surgeon was Peter Liao at GBMC...I have Johns Hopkins priority partners through medical assistance...I was originally scheduled for surgery dec. 27 2012 and was denied 3 times I had to fight them the whole way, they kept denying for not showing enough weight loss during monthly weigh ins so I was advised to keep a food journal and come in for 3 months of successfully weigh ins...which I did and GBMC submitted my weight loss along with,y 3 months of eat journals to them and I FINALLY got approved! My surgery was 6/6/13 I hope you don't have to go through what I did

[Andrea Allen 5]

Hi from MD my surgeon was Peter Liao at GBMC...I have Johns Hopkins priority partners through medical assistance...I was originally scheduled for surgery dec. 27 2012 and was denied 3 times I had to fight them the whole way' date=' they kept denying for not showing enough weight loss during monthly weigh ins so I was advised to keep a food journal and come in for 3 months of successfully weigh ins...which I did and GBMC submitted my weight loss along with,y 3 months of eat journals to them and I FINALLY got approved! My surgery was 6/6/13 I hope you don't have to go through what I did[/quote']

Also my bmi was over 40 and had comorbidity

[shannyd4 28]

Omg it was crazy!!! So my BMI is 42 with no health problems ... I completed my 6 months but during the 6 months , I gained 6 lbs... When my info was sent to EHP, they denied because I gained weight... Ok cool... So then that says if i take 3 more months of classes, loss some weight and keep a journal, they would approve it... Again, they denied me... Stating that, I had mc Donald's once and a glass of once... So I was going to give up, because I thought it wasn't meant for me.. But then I realized how much time and money, I've invested so I emailed the president of the hospital and I CC hope marsh, benefits director... The next day my decision was overturned.... My advice to you... Journal, lose some weight... I would advice maybe a pound or 2 a month at the lease... Ehp has another medical director and since he's been there, he's been denying everyone's claim....prior to that, everybody was approved.... It's crazy...

[LisaDM 194]

Yeah, that is partly my concern. I started weight watchers in January and lost some weight but then gained some, so I am actually up since my first weigh in. The surgeon advises me to lose 5-10 lbs before surgery and to do a food journal. I have lost 2 pounds, but haven't filled out the journal. I use my weight watchers app, so I amazing to see if I can print that out. Hopefully the 5-10 will be enough. My BMI is only 36 but I have high blood pressure, GERD, and back issues. The back issues aren't caused by my weight, but certainly worsened by it.

[shannyd4 28]

So u dont have to complete 6 months of classes because u did weight watchers?!

[LisaDM 194]

Weight watchers is included in the options for the 6 months weight loss classes. I do have to do two NUT appts as well. One group and one individual.

[LisaDM 194]

I also did a weight loss clinic that uses phentermine last year. I lost 40 lbs, but have since gained almost 20 back. The coordinator advised me not to use that with my submission since I gained after stopping the med.