Amerihealth Nj - Does Anyone Know The Requirements?

[SandeeD 363]

I'm going to have to switch insurance companies before 1/1/14 and I'm leaning towards Amerihealth. I know that they cover bariatric surgery, but does anyone know what the full list of requirements are before submitting for approval? Thanks in advance!

[Thick'n'Thin 171]

I'm going to have to switch insurance companies before 1/1/14 and I'm leaning towards Amerihealth. I know that they cover bariatric surgery, but does anyone know what the full list of requirements are before submitting for approval? Thanks in advance!

I don't know the answer but I found the doctors office knew better than even the insurance representatives what was needed. Hopefully they can answer your questions tomorrow. I just know that my insurance, which I was told by insurance CS requires 12 months of supervised diet before approval, is in fact very simple to go through now.

Good luck!

[PhickDiva 0]

I have AmeriHealth NJ PPO. I just went for my consultation with Dr. Attia on 11/27, and was given a packet explaining some of their requirements. Here's what I have thus far:

- 1 Psych Evaluation

- 3 Nutritionist Visits { * It SAYS 6, but a patient got accepted after only doing 3 last week *}

- 3 Support Group Classes { * One per month * }

He's going to do an endoscopy for me on 12/18 which is part of his own requirements. That has nothing to do with AmeriHealth. He's not going to submit all my paperwork until all of the above has been completed, but he said there's a chance AmeriHealth may or may not add more later to my to-do list. So I'm not sure. There's NO pre-op diet rule in place by AmeriHealth currently, but he said he'd like me to lose a couple pounds -- even if it's 2. As long as I don't gain, he's fine.

[Chele H 427]

Is your insurance through your employer? Regardless of the insurance company, if your insurance is provided by your employer the coverage is totally dependent of which policy your employer chooses and if they choose a bariatric surgery exclusion. I urge you to contact your human resources department and/or the actual insurance company and get specific written guidelines.

Good luck!

[SandeeD 363]

No, I pay for my own insurance. Regardless of which Amerihealth plan it is, if the plan covers bariatric surgery, I can't imagine that the there would be different requirements since all of the "plans" are Amerihealth, right???

[PhickDiva 0]

I agree. I think the requirements would still be the same, regardless of if your employer pays or if you self pay. That shouldn't matter. I would imagine the only difference would be how much they cover and costs. Like my plan is through my job, so AmeriHealth will only cover 50% of the surgery cost and 50% of the surgeon's cost as long as the $2500 deductible is met. My boss has to pay for the rest. But that has no effect on my requirements. The packet I was given for AmeriHealth NJ was the most recently updated one they have for this year, but the girl in the office said if there were any changes she'd let me know ASAP. So I'd say for a couple classes, nutritionist visits and 1 psych evaluation, that's not too bad at all. No pre-op diet, sleep study, or anything else like others have had to do.

[laurenella82 625]

What PhicDiva posted are the basics. All the other stuff will probably depend on your medical history. Like I have a history of mitral valve regurgitation so I have to get another EKG. I have a history of swelling in my lower extremities and osteoarthritis so I have to get an ultrasound. If you don't have any co-morbidities then you may not have to do much else. I have Amerihealth but I'm in DC. I'm just praying I can have my surgery in February.