IBC Personal Choice PPO in PA coverage

[jadira30 5]

Hello all. I have IBC Personal Choice PPO coverage in PA. I was wondering if anyone has this insurance and been sleeved. I have all my pre-op things like nutrition classes (2) my psych evals (2) my sleep studies and now been on c-pap for 1 month faithfully (actually love it), my hgbA1C is 5.9 so heading towards diabetes, excruciating foot pain and knee pain. I'm 5'6" 243 lbs so my BMI is not that high. I have my surgeon consult on the 8th of August. I'm so afraid I will be denied. Can anyone please tell me what to do to make this sleeve happen. I need help. The sleeve is my only hope. Dieting and exercise or diet pills dont work! I am tired of the yo-yo'ing weight. Any help will be greatly appreciated.

[Brownrek 21]

I have personal choice PPO in pa and was covered. My bmi was 35 but have high blood pressure and had slightly high blood sugar. Call the number on your card and ask if it is an excluded service. Where are you and which surgeon are you seeing?

[Tiny One 223]

I have same insurance. Starting weight was 198, sleep apnea, joint/back pain & GERD. Borderline diabetic, approaching HP & High cholesterol. My BMI was only 38.7 & I was approved with no problem.

[jadira30 5]

OMG!!! thank you soooo much for your replies. I feel more at ease now. The med policy is a tad confusing in regard to bmi in the 1 or 2 step procedure coverage. I called the cust service number but the rep said WLS is covered but that it is dependent on a different depts approval. No help at all. But I am so glad I found this site. I plan on using Dr. Yves Manigat out of Voorhees, NJ as he performed my husbands surgery. My spouse had no problem as his bmi was 59:/ Now how many nutrition appts were needed? I only did 2 and the nutritionalist said that was all I needed. I also did 2 psych evals because nut said thats all I needed. Is there anything else you can think of that I need to do before submitting to avoid a denial? I am in Philadelphia, PA>

[Tiny One 223]

I had to do:

1 psych eval

sleep study

2 classes that included the NUT

Arterial Blood Gas

Upper endoscopy

A ton of labs

1 initial consult & 1 pre-op with surgeon

ultra sound of abdominal area

1 pulmonary visit for clearance after sleep study

I also had to make sure I had my routine GYN exam & mammogram (ibc may not require this, but my doc told me she wouldn't do the surgery if I hadn't.)

This is all I could remember.

[Brownrek 21]

I only had to do 1nutrition consult and 1 psych consult. Also about a gallon of blood, blood gas, chest X-ray, abdominal ultrasound, consult with primary physician and surgeon. I do not have sleep apnea or snore so didn't need sleep study. They said sometimes pulmonary and cardio consults needed but that depends on other symptoms. I went to abington so don't know how much of this is their requirements vs insurance. Personal choice says bmi of at least 40 if no other conditions and 35 if any other comorbiblity. My bmi was 34 so had to gain 8 pounds to get to 35. After I saw the surgeon I had my approval letter within 2 weeks. Good luck!

[Tiny One 223]

I only had to do 1nutrition consult and 1 psych consult. Also about a gallon of blood, blood gas, chest X-ray, abdominal ultrasound, consult with primary physician and surgeon. I do not have sleep apnea or snore so didn't need sleep study. They said sometimes pulmonary and cardio consults needed but that depends on other symptoms. I went to abington so don't know how much of this is their requirements vs insurance. Personal choice says bmi of at least 40 if no other conditions and 35 if any other comorbiblity. My bmi was 34 so had to gain 8 pounds to get to 35. After I saw the surgeon I had my approval letter within 2 weeks. Good luck!

Brownrek, I went to Abington too. Did Dr. Noonan perform your surgery?

[Brownrek 21]

No, I had Dr. G. Just went yesterday for my one month post op. He was wonderful.

[Tiny One 223]

O ok, the entire team at Abington I thought was great.

[morningdew 9]

I have this same insurance and I'm going through the process now. Having mine done at HUP with Dr.Williams.

They require:

1 sleep Study--> 2 if you're diagnosed with sleep apnea and a visit with the sleep doctor

Upper GI

Chest Xray

Pulmonary function test

1 Nutrition class

1 Psych eval

Lab work

Internal medicine consult with pcp

3 Medical weight management appointments

1 support group meeting visit

I only have 1 more medical weight management, psych eval and nutrition class to go. I can't wait to get my surgery date!

[jadira30 5]

I have my consult with surgeon tomorrow. Soooo excited. I have all the required documents so im hopeful that he will submit to my insurance tomorrow. Im nervous though. I need this sleeve like i need air!!! Please pray for my approval everyone. Im so thankful for everyones replys. I will post again tomorrow after my consult. FINGERS CROSSED!!!

[Tiny One 223]

I have my consult with surgeon tomorrow. Soooo excited. I have all the required documents so im hopeful that he will submit to my insurance tomorrow. Im nervous though. I need this sleeve like i need air!!! Please pray for my approval everyone. Im so thankful for everyones replys. I will post again tomorrow after my consult. FINGERS CROSSED!!!

Good luck! You have a pretty good chance. I do know IBC will require it be done at a Center of Excellence facility. What hospital do you plan to use.

[jadira30 5]

My surgeon works out of Virtua Health System in Voorhees, NJ. Dr. Yves Manigat is a very well known bariatric surgeon. He owns and operates Echelon Bariatrics center. I will ask many questions this afternoon. My appr is at 2:30pm. Im so nervous but super excited just thinking about my new life. Thank you all for ur support

[jadira30 5]

At my appt. sitting here waiting. Im a bundle of nerves!!! I soooooo need this to be approved!!!! Praying hard!!!

[jadira30 5]

Well, I say my surgeon. I had all my documents in order. He will be submitting to insurance company on Monday. Now the waiting for approval begins. Hopefully everything will go as planned.