Need advice - State of AZ Insurance

I work for ASU and have State of AZ Insurance which is self-insured. We are in open enrollment until Friday 9/8 and I was wondering if anyone had better luck with United Healthcare EPO or Schaller Anderson EPO for getting approval for lap RNY. What co-morbs and BMI were required? Did you have to have a history of weigh loss attempts? If so, how long? Thanks for any advice you can provide.

I had surgery 4 years ago and it was for DS. I had UHC EPO they were great! I know they want a BMI of at least 40 not sure what else anymore. Good luck I was approved very easily.

Thank you Stephanie. Unfortunately even though I have UHC EPO and they are great, since State of AZ is self-insured, they have their own criteria that they make UHC go by. By the way, your before and after photos are great and inspirational. Thanks again, Sandi

Sandi, I'm also a state employee and in previous years, the state opted to not cover this surgery for employees. I don't know what's in the new insurance package, but I would suggest calling a couple of surgeons' offices and see what their insurance specialists know about it. If your agency is anything like mine, it's impossible to get accurate information from the insurance liaisons. Scottsdale Bariatric might be a good place to start. Best of luck, Connie

Thank you Connie. I appreciate your advice. Take care, Sandi

Sandy Call the insurance company - Both of them and ask ! They will give you all the info .Some of the company's even have a website with the booklet and all the requirements . I personaly had United and had no problems - I called they told me what I need and got approved in a matter of hours - The insurance comp will also tell you if there is an exclusion on the policy for WLS .

Hi Jeanna, Thank you for the advice. Unfortunately I am also under the constraints of State of AZ, and not just UHC, since the state is self-insured. I am hoping my PCP will sign-off on my weight loss attempts over the last year that were supervised by a MSW and I am hoping that will suffice for UHC and the state. If not, I am going to have to go through a six month physician supervised weight loss program. I don't mind doing it but I was hoping to get the surgery in December. Wish me luck! Thanks for your help. Take care, Sandi

I had lap RNY in July 05 - at the time I was an ASU employee and had UHC. I think I still have a list of the requirements from early 05 but they may have changed - actually, it may still be on my profile. You have to have at least one life threatening comorb (I qualified with high blood pressure and asthma) and your BMI has to be over 40. You have to do a 6 month physician supervised diet and lose 10% of your current weight. Good luck! Gabrielle

Hi Sandi, My experience, my husband is a State of AZ employee and we have UHC EPO, I was told last summer that they require a 10% loss of body weight and a Dr. supervised program, I did Dr. Emmerschaad at Scotts Bariatric for 5 mos., paid $500 and she told me they stopped the requirement. I did get a letter from my primary Dr, do have high blood pressure, did get any documentation of past attempts over the years (OA, Weigh****chers etc..), copies of books I bought etc...took a few months to think about it, went in May for my initial consultation, all day, paid $500, was given a laundry list of things to do meanwhile they sent in my packet to ins. I was denied because I didn't have a sleep study??????! Two days later I had it, it was already scheduled and do have apnea and filed an appeal by faxing my results to the care coordination department and had an approval letter 3 weeks later. My surgery is scheduled for 11/80/06. The only thing I would suggest is getting all the stuff they recommend done quickly so they can submit it with your packet. GOOD LUCK!! Hope this helps. Katie