Does anyone have PCIP?

[LissaLou 6]

Just wondering if anyone has been successful getting PCIP to approve the surgery...please share your experience. Thanks!

[countrygirl 84]

Just wondering if anyone has been successful getting PCIP to approve the surgery...please share your experience. Thanks!

Mine was all on board no problems getting his opinion/advise.

[MamboMan 6]

Just wondering if anyone has been successful getting PCIP to approve the surgery...please share your experience. Thanks!

PCIP? Is that a Pre-condition Insurance Plan? If so, I have no idea...sorry.

[LissaLou 6]

Yes, I'm referring to the Pre-existing Condition Insurance Plan (PCIP) that is federally managed. No one seems to have any idea about it including most medical offices. Sigh...

[monola 19]

Yes' date=' I'm referring to the Pre-existing Condition Insurance Plan (PCIP) that is federally managed. No one seems to have any idea about it including most medical offices. Sigh... <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/sad.png' class='bbc_emoticon' alt='' />[/quote']

I have PCIP and they said Six months with nutritionist and an independent psych eval and I am good to go. Trying to get my surgery in Oct, still I worry about jan 1, 2014

[LissaLou 6]

What state are you in, Monola? I'm in NC. I have to do a 6 month medically supervised diet and exercise program. I am not required by PCIP to see a nutritionist or have a psych eval to get approval for coverage. However, my surgeon does requires those things. I guess I thought that PCIP was federally managed and that all states would have the same requirements.

[monola 19]

What state are you in' date=' Monola? I'm in NC. I have to do a 6 month medically supervised diet and exercise program. I am not required by PCIP to see a nutritionist or have a psych eval to get approval for coverage. However, my surgeon does requires those things. I guess I thought that PCIP was federally managed and that all states would have the same requirements.[/quote']

I live in New Orleans and my doctor requires the psych but PCIP told them the psych needs to be given by an independent psychiatrist and not one with the program. Are you concerned about insurance next year during the post op?

[LissaLou 6]

My psych consult was with an independent doc, but I was given a list of docs to pick from. Yes, I am concerned about insurance after December 31. I'm just hoping that the PCIP program will morph into something similar and we will be offered that coverage. If that does happen, I'm wondering how much it will cost. When the program went from state-managed to federally-managed on July 1, my monthly premium DOUBLED! Have you been approved by PCIP for surgery yet, Monola?

[mswisdom 42]

I have PCIP here in Virginia and the first thing I did after they said that they pay for surgery is for them to email me the criteria for surgery.

They emailed it to me and once I went to my first weight loss seminar the surgery scheduler told me everything that was required for surgery.

6 months PCP visits (I'm on month 4)

Physh clearance

Dietician appt.

Chest xray

Ekg

Lab work

Cardiac clearance (I have stents)

The actual program I'm going through wants

1 group meeting

Mammogram

Colonoscopy

And $120 for 6 1hr personal training sessions.

All of my things are done, except the PCP visits. They said they would pull my records in month 5 for submitting but my PCP doesn't work fridays and my July appt. was pushed to August 1st.

That's no big deal because my albumin & Iron is low so they gave me 4 weeks to bring the numbers up with Protein shakes and Iron pills. Other than that I'm ready to go.

Hopefully I'll have a date by the middle of August when my labs are redond, I'll keep you posted.

[monola 19]

I talked to the person at PCIP she said that after all requirements are met and sent to PCIP that it is usually about 30 days until they approve it. So it seems that I will have the surgery around thanksgiving. I was told nothing about PCP. What should I get from my PCP. What tests should she order?

[LissaLou 6]

Your surgeon/bariatric team should be able to give you a list of their requirements. PCIP can email you what they require - ask for the bariatric surgery criteria.

Be sure you get the requirements from both parties (your surgeon and your insurance company).

[mswisdom 42]

I have PCIP and they said Six months with nutritionist and an independent psych eval and I am good to go. Trying to get my surgery in Oct' date=' still I worry about jan 1, 2014

[/quote']

I'm worrying about Jan 1st also. I've been on this road since march and its heartbreaking to think that all my work will be for nothing.

The good side is starting Oct. 1st you can go into healthcare.gov and look at all the plans to choice from and I'm going to make sure that they have wls as a ryder.

My surgeon told me Monday that I will get an appt. by Dec. 31st since my last PCP appt. Is Oct. 8th (9 really sine I have to see a nutritionist, but I only have to go once)

[mswisdom 42]

Your surgeon/bariatric team should be able to give you a list of their requirements. PCIP can email you what they require - ask for the bariatric surgery criteria.

Be sure you get the requirements from both parties (your surgeon and your insurance company).

I immediately received the criteria letter from PCIP for wls. It came in handy because the so scheduler said that they didn't pay for the sleeve, but I was able to pull up the paperwork and show that they did. Don't know which one I'll be having but Insha Allah (God willing) I'll have one by the end of the year.