Arizona Foundation Insurance

I work for the State of Arizona and have Arizona Foundation Insurance. I am trying to find out if anyone out there has been successful in getting them to pay for gastric bypass surgery. Any information would be appreciated. Thanks Donna

Is it Arizona Foundation for Medical Care? AZFMC is a network of Drs not a specific insurance plan per se. www.azfmc.com "Our unique difference is that we are not a single plan or insurance company but a managed care network and medical management company. Arizona Foundation works directly with insurance professionals, such as brokers, consultants and general agents, as well as third party administrators and insurance companies." For example, I have MMSI (Mayo) with the City of Scottsdale and I can use Drs/facilites that are part of the AZFMC network. But my insurance is not specifically called AZFMC even though they do have the contact info on the back of my insurance card under the customer service number for MMSI/Mayo. Insurance is confusing and tricky...but it is important to know what plan/policy/coverage you have since it varies so much...and as a state employee to know what the state has contracted for....unfortunately it's not easy to compare apples to oranges.

Hi, I have Az Medical Foundation and they do cover the surgery up to $10,000. It has to be medically necessary, proof of diet for 6 months, see a nutritionist, and psyche eval. The last two things have been difficult for me to find someone who takes our insurance. I had to do a sleep apnea test also (im doing tonight). I have not submitted to the insurance yet. I am waiting until I have done everything before submitting to the insurance. I dont want to have to deal with any appeals. If you know what I mean.

I'm just starting the process....I'm sure it will be more than 6 months before I find out whether I will be approved, as I haven't met the "letter of the law" yet re: 6 mos. of physician supervised weight loss. I do know it will be denied if you cannot substantiate it is "medically necessary" and "required by a specifically identified condition of disease etiology." I have been on the phone all morning trying to get a copy of the prior authorization criteria, and after speaking with 8 people, including a person in ADOA, it appears it is a "secret" document, although a couple of people offered to read it to me. I have asked for a copy of the document, or something in writing citing why they cannot legally provide it to me. I suspect it will take a letter to the Governor before I get that (if then). As for the criteria, here is what I was told (there may be more): Six mos. of physician based, supervised weight loss (WW etc. does not count) to include dietary therapy, behavior therapy and consideration of medication; psychological evaluation; 100 lbs over BMI; severe medical condition such as severe cardiopulmonary problems; 5 yr history of severe obesity; medical assessment; nutrition counseling; exercise counseling; support group; psychological counseling; in-network provider. I doubt it is limited to $10,000 as was previously posted, unless that is the contracted rate for the provider. And while a previous poster is correct that AZ Foundation is not technically an insurance plan, it is a choice of "insurance plan" (PPO providers) for AZ State employees and retirees under their self-insurance program. I also learned an interesting thing today: while the plan is administered by Harrington, the prior authorization is done by Schaller (which is another provider choice we have). Weird. Leave it to the government to involve all kinds of companies!!!!