Any one with AHCCCS!!!!!!!!!!!!

I seen there were people asking about AHCCCS. Well I have them and let me tell you. I did a lot of research worked with my Dr for over 4 yrs and they will not pay for it. This is what they do, they change the "criteria" as they see fit so they do not have to pay. You have to be knocking on deaths door and then they might think about it. All the AHCCCS plans are the same. I have dealt with this for over 4 yrs and have decided to go south of the boarder and self pay. I no longer can sit and wait to die because the state says I don't fit their "criteria". When I do need the surgery. And I do fit the criteria. I have letters from a lot of other providers and have co-morbidities. They require proof of 5 yrs of diet plans and it cannot include diet pills weigh****chers or Jenny Craig or anything to that effect. You have to have atleast 3 co's and they have to be uncontrolled like if you have diabetes, it has to be uncontrolled by insulin and have a letter from an endocrinologist saying that it cannot be controlled, and if you have sleep apnea it as well has to be uncontrolled by a c-pap or bi-pap machine and a letter from a sleep specialist saying that it cannot be controlled either. You have to be over weight more than 7 yrs. You have to have 2 m.d. supervised diets, with going every month with the first one being 6 months and you cannot miss one month. So that takes about 100 weeks to complete. You have to lose over 10% of your body weight. There is a certain way that the notes have to be dictated. You have to be able to pass a psych test. And if you call the ins comp. they will tell you they do not have a provider that is in network. It has to come from your primary because it is an out of network service. And good luck getting on getting an auth number for anything if they add up your trying to get the surgery. So I am so glad that I do not have to sit and wait for them to decide they will pay for the surgery. I feel sorry for the people that need this surgery and have AHCCCS. I had a friend that was over 600lbs and they would not give her the surgery. She is dead now, as a direct result of her weight. Good luck to any and all that have AHCCCS. If you do get approved, then you need to let every know how you did it. Because that would be a miracle. If you have any questions please feel free to e-mail me. I have all the criteria. Tanya

Hi TanyA! I had AHCCCS and Medicare and it was paid 100%. It took me two years and I jumped through hoops but got it through. All the above things will be required by just abiut ANY insurance company. And I didn't lose any weight -- I gained 30 pounds. Sheryl

You sound as if you have given up. I have AHCCCS Mercy Care and I have been trying to get all the required things they list completed. But I am not going to give up because of how you feel. I only have to loose the 5% body weight and get a sleep study completed and the if God is willing I will be approved. But I will let everyone know. I have heard that AHCCCS will usually denie you at first and you just have to appeal.

Hi Jessica. No I have not given up I have decided to take another route and get it done that is all. I did not write that message to discourage anyone from trying. I just thought that 4 yrs was long enough. I was only responding to the post that were posted that is all. I hope that you dont give up or anyone else for that fact. We have spoken before about AHCCCS. I am sorry if anyone got offended. I was only stating the fact that I have been dealing with them for so long and that is what it has been like. I have talked to numerous people that have gotten denied to the end. And they needed it worse than me. So sorry if you or anyone else got offended. Good luck to you in your wls journey. I wish you all the luck in the world. Tanya

I was wondering -- since you're having surgery in Mexico what are you going to do beyond that -- like aftercare, checkups and support groups????? Sheryl 320-210-170

Hi Sheryl, I have worked out with my primary to do checkups and he works with some bariatric dr's here in Phx so I have back up if I have problems. I also go with my mom to her support groups, she had her surgery done Feb and I have been all to her pre-op classes and support meetings with her. I am glad that AHCCCS paid for yours. I see you had Medicare as your primary and thats prob why AHCCCS paid is they only had to pay 20% or whatever medicare did not pay for. But I am happy for you that it worked out for you. I just felt like 4 yrs was just ridiculous to wait any longer. My old primary doc. destroyed any chance of what I had to get approved by AHCCCS. So my new dr said that I would be better off to look into diff ways of getting it done. My prim works with Dr. Juarez and Dr. Villares ( I believe that is how you spell it ). He has worked with patients to get them approved, so I trust him as far as criteria knowledge and such. And I was only replying to the post that were about AHCCCS. I did not mean in any way shape or form for anybody with AHCCCS not to try. I was just telling my experience with them and maybe it would help someone that is going for it with AHCCCS. I did not mean to offend anyone and sorry again if I did. Tanya

Hhhmmmmm...check out my profile-I also am getting my surgery paid for 100% by HealthChoice/AHCCCS. When I finally got to someone in the Appeals Dept.-it was Easy Street-two appeals for the actual surgery and TONS of documents, phone calls from hell and I'm in.It took about 2.5 years.-Emmy

Tanya, Hi, I have AHCCCS APIPA and my surgery was paid for 100percent. I seen my surgeon for the first time on November 9th 2005 and had my surgery on March 20th 2006. I wouldn't give up so easily. I know it is a rough ride, but I would keep on them and for my surgery they only required a 6mo. doctored supervised diet. So I'm not sure what the 5 years is about. Good luck on your journey, my sis in law went to Tijuana to have the band done in Dec of 2005 had the most wonderful doctor and we had a blast....Much luck.. Sondra, 315/230/150 85lbs gone forever!!!!

hello tanya , i just got approved to have the surgery i started in january 2006 and with my patients and some good doctors that believe in me and this surgery ..and again my pushing to get my name across to them and my self i dont have any other health problems besides obesity and depression not in a ward or anything just depression but ahcccs finally approved me i just got the word and ill still even scepitical on if they called the right person ...lol no but really just hang in there i was giving up more than once and found a decent dr in mexico but its worth the wait .. check out my profile and maybe if you need help with anything let me try and help u as much as i can since i have all the numbers to ahcccs you need ..lol