Re: Re: PacifiCare PPO

[Guest guest]

Thank you Cassandra,

I too felt like I had nothing to lose and so have fed-exed all my

papers to the pre-determination department including the PacifiCare TAG

review, my HMO approved letter for gastric bypass surgery, diet history,

family history, my personal letter, letter from my PCP, lab results from my

chart, evidence of physician-supervised diet, papers on the DS, and assorted

odds and ends. Hopefully they will see this overwhelming information and

approve me on the spot if they are able to do so. That is the key. I can

not make my flight reservations until I hear from them. I sure could use

that luck you offered.

Janice in Texas

Re: PacifiCare PPO

> Hi Janice,

>

> I'm not sure about the Pacific Care PPO but I had the same exclusion

> in my Pacific Care HMO policy. I just ignored it and all the policy

> experts that said I couldn't have the surgery and I carried on with

> my mission to have DS. I may have been one of the very lucky ones but

> I was approved. I did have to write a letter to them that my Dr. sent

> in with the LOMN. They would have wanted me to go to San Diego for

> the RNY. In the letter I mentioned that I was a canidate for the

> surgery based on the NIH guidlines, Listed my medical problems and

> those of my family history I faced without getting surgery, a list of

> all the diets I failed at in the past and lastly why I wanted the DS

> over the RNY. gave me permission to attach information as

> backup from the DS website as well as the Hess/Rabkin reports. Best

> of luck to you.

> Cassandra

> DS 4/16/01 Dr. Keshishian

>

>

>

> > Hello, Has anyone gotten approval for WLS through PacifiCare PPO?

> > I just called them and they say there is an exclusion for any

> treatment for

> > 'Obesity'. I said that is a completely different diagnosis

> than 'Morbid

> > Obesity' or 'Clinically Severe Obesity'. She still said no. I

> have sent my

> > papers in for a Pre-determination of therapy for WLS but the wait

> time

> > conflicts with my need to get plane tickets for my consult with my

> surgeon.

> > If I knew they DO cover the DS then I would go ahead and make my

> consult

> > appointment and wait for payment after the fact but I would hate to

> pay the

> > approx. $1000 dollars of all involved costs for getting to the

> consult if

> > there was no chance of them approving the surgery and consult. I

> had

> > PacifiCare HMO where I was approved for gastric bypass surgery but

> was

> > denied from going out of network. Now my insurance is changing to

> > PacifiCare PPO and I can go out of network but now the approval is

> in

> > question. HELP!!!???

> > Thank you,

> > Janice in Texas

>

>

> ----------------------------------------------------------------------

>