Any personal papers/etc.I can use to up my chances of Ins.approval?

[Ypsibander 0]

I just spoke to surgery clinic today and they are sending out papers to me to give to PCP to fill out and submit to Insurance. I have Health Alliance Plan (HAP)HMO of Michigan . I am going to my PCP on 5/28 and will bring these along. Do you know if this "paperwork" is what the Dr. will fill out to get me pre-authorized or authorized? I am wondering if I can bring anything along to up my chances when it's sent in? I know six months of diet/exercise is required (not sure to what extent),BMI w/co-morbidities, psych eval, and I think that was about it. I thought maybe like Weight Watcher booklets, copies of gym memberships, any personally written letters..not sure if that even matters?! Any advice?? Thanks so much!!

[singledad167 0]

Hi, I'm sorry, don't know much about the insurance requirements, but I'm also from MI and just wondering what doctor you're using.

[Ypsibander 0]

My ins. requires me to use Henry Ford Hospital in Detroit, Dr.Genaw and Carlin do it there. How about yourself?

[singledad167 0]

My ins. requires me to use Henry Ford Hospital in Detroit, Dr.Genaw and Carlin do it there. How about yourself?

Dr. Schuhknecht from Lakeland hospital. He used to be in Detroit and has done over 4000 gastric bypass, and 700 lapbands. Good luck with the ins, I hope all goes well.

[willowcrown 1]

I too am from Michigan. Now, I had BCN, which is another HMO. They told me that I had to go to Henry Ford for consideration of surgery. It took me over a 1/2 hour on hold to actually speak to a real person at Henry Ford. When I finally did, the girl I spoke with was not only unhelpful, she didn't even follow up or send me any of the info she said she would. After trying to follow up twice, I was still no further ahead so I just changed my insurance.

I am 90% sure that all the HMOs make you do 6-12 months of supervised diet and excercise. I was told in my case, even though I had three significant "co-morbidities" that they still wanted me to go the non-surgical route. I know someone who was on HAP and that is what they were told as well. After 6mos of dieting, this person lost about 30 pounds. They considered her efforts successful and would not consider her for surgery. Not that I'm suggesting you sabbatoge a diet, but take the info for what it's worth.

Good luck to you.

[jaria007 2]

Do you know anyone at your company who has had weightloss surgery? I, for one, got together with my coworker and reviewed all the paper work she turned in to the insurance in order to get her approval. I then drafted the same letter she used, only using the statics my doctor had from my 6 month diet etc, and brought it to my PCP. He reviewed it against the file and signed it. I then went to my psych doctor and had him do my psych consultation and write a letter saying that i was a good candidate. Finally, I went to the nutritionist who also wrote my letter. I faxed it to my surgeon who faxed it to my insurance company and i had my approval 3 hours later. all insurances are different because they are guided by company requirements, so your best bet is to (if possible) seek out the help of a coworker who was approved. Hopefully that is an option for you. It is all about submitting what they want in the exact format they want, and it is all a guessing game until you give it a go. good luck!

[Kate228 0]

A letter of "medical necessity" from my Primary care Dr. was submitted and helped alot!!!