Medicaid *** Customer Service Reps Playing

[Tosha-248 21]

I understand that everyone needs some type of help and i just like others have medicaid with either molina, meridian, total healthcare, harbor health, United healthcare or etc etc etc.... but when you call and give them you insurance id number and they ask you your basic info name, dob, address, phone and etc etc.... they say what can i help you with today and sooooooon as you say i'm calling to get Bariatric Surgery requirements and all you hear in the back ground is smaaaccckkkk like you irritating them this is there job and they suuucckkk at it so bad then she says well you will need to have a prior authorization form and then when approved we can give you more information then you say i understand that but i just want to know the next step so i can better prepare myself and make sure my primary care physician is on the same page so next the rep says well if your doctor is referring you to weight loss surgery then they should be informed and up to date or you need to seek a new doctor and if you are approved you need find a surgeon and ask him for a new pcp to help guide you through the process so i'm already upset because i had insurance through my job that i was paying for but i was told i qualified for the health market insurance with Department of Human Services so i figured that money could go to my kids and get the free insurance instead of 300.00 a month but with the attitudes you get from the customer service reps with they put the state health card id number in is horrible they act like it comes out there pocket this is another reason why its so many people sick out here they refuse to ask for help because the insurance reps do a crappy job at answering question there upper management needs to call and act like a customer and start firing there reps or put them in a new training class on how to help people instead of how to piss the customer off because if we as the customer knew the information we would not call but i'm sorry to be so long and not get grammer but i was pissssed and upset and need to vent i rather pay and not deal with insurance my Blood pressure has went up 180/118 im on two bp meds and Water pills and i cant believe i let this woman get me mad today

[MollyF22 62]

I am from ohio and have caresource. That's from the state. I am completely paid for and I will have surgery Feb 12th. It was a 9 month process seeing my surgery doctor. I only did 2 clearances. Usually the office you go through or whatever, they will let you know what you need to do and get you through your process. You can ask your primary doctor who you can go too or call around to local places. Search online or ask anyone on here who they have or if anyone is around you.

[MollyF22 62]

Alot of people do a half asked job in these days for some reason. Some people just don't care and only care about their pay check. It's not right and I'm sorry you went through that.

[Tosha-248 21]

Thanks MollyF22 i'm just going to wait it out it until March 2016 and start all over they have changed my insurance 4 times because the county has stop covering different insurance so i have been push from one to another but i will try again and i will keep my head up thanks again

[Bethany Copley 35]

I know Molina Medicaid requirements, as im in their program.

12 counseling visits (psych)

12 nutritionist visits

12 Physical Therapy visits

Lose 5% of weight

All of these requirements need to be completed within 180 days of your acceptance date into the molina bariatric program. The only way to get referred is through your doctor.

ALSO...Molina cannot tell you this, but in their policies, it only says that the requirements must be met within 6 months...that means that if you had counseling, PT and Nutritionist appointments once a week, you would have completed the program in 3 months. Then you just have to complete the surgeon requirements, which is usually a bariatric psych eval, EKG and blood labs. Sometimes more testing if you have apnea or diabetes.

[Tosha-248 21]

Thanks also do you or anyone have united health care community plan requirements

[Tosha-248 21]

United health care have about 3 or 4 different plans connected

[Bethany Copley 35]

I found this...I dont know what state you are in, though. https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf

[Tosha-248 21]

Michigan

[Tosha-248 21]

Thanks I had that one already but it doesn't give e hat state or if it qualifies all UHC OR UHC choice or UHC Plus thanks Bethany for evening so kind.

Did you have your surgery yet?

[Bethany Copley 35]

Not yet. Im in the middle fo getting all my reqs done Just super interested in helping other people.

In my former "life" prior to anxiety, I was a community resource specialist lol

[Tosha-248 21]

Well your doing a great job now and I thank you for your help and good luck with surgery and keep everyone up to date when you can

[Bethany Copley 35]

You too! <3

[Tosha-248 21]

Thanks I will

[craftygal77 22]

I have uhc Medicaid from Michigan, I started out with a seminar, and made an appointment with the surgeon. They got pre-authorization from uhc and listed the requirements. I need a 12 month supervised diet plan, I need to lose 5% of my body weight, psych evaluation, ekg. I am almost 11 months through, after all this I'm hoping it gets approved. If you start your journey with a seminar they have insurance coordinators that can guide you.