RAN+AMN Insurance

Has anybody here gotten approved recently through the state employee RAN-AMN insurance and if so, how difficult was the process. I have decided on Dr. Blackstone and have signed up for my first public seminar and I am waiting for the insurance to send me the approval criteria. I am especially concerned about having to do the 6-month medically supervised diet and what that entails, like can I see the surgeon first and get going w/ that or do I have to go back to my regular doctor and complete the diet with them first. Or, is there any experiences w/ not having to do the 6 month diet w/ this insurance? Any feedback would be appreciated.

Hi Rebecca, I am a state of AZ employee with United Healthcare. Even though RAN-AMN may have their own criteria for coverage, the state of AZ has additional criteria above the insurance company. In fact, United Healthcare is one of the easiest to get approval through but due to being a state employee, I have had to jump through many hoops. Since the state of AZ has an exclusion policy for covering weight loss surgery with all of the insurance plans, I believe their criteria is the same for all. I have attached, at the bottom of this message, the criteria that I have that was effective back in 2005. I am still trying to get ahold of the current criteria but it is pretty much the same. If you receive criteria that says you are required to "acheive a 10% weight loss to demonstrate committment, based on a recent UCLA study," it is out-of-date as it is my understanding that the 10% weight loss requirement has been removed. Unfortunately, the 6-month physician supervised weight loss program is one that most people can not get around. In fact, most insurance companies are moving toward requiring that of everyone. I was really disappointed in the beginning because I had hoped to get my surgery back in Dec. but had to complete the 6 months. I will be submitting my appeal in April. I had completed a 10-month diet program with my counselor but they would not accept that. I did see the surgeon for a consult prior to submitting the first request for insurance coverage. However, I was not able to move forward with any of the medical tests required by the surgeon since I did not receive coverage. I haven't heard of any surgeon that will set a surgery date unless the patient is self-pay or has received insurance approval. I do now believe that it was a good thing that I didn't get coverage back then because I had selected the wrong surgeon plus I have learned so much over the past 6 months that I know will help me to be successful after the surgery. I think you have selected a great surgeon though. I have heard a lot of positive feedback regarding Dr. Blackstone. In fact, my aunt had weight loss surgery with her about three years ago. I would have selected her as my surgeon but it is my understanding that she is no longer taking United Healthcare plus since she is so popular, her schedule is booked out pretty far. Dr. Blackstone's office does have a physician that can do your 6-month program but I was not able to afford the out-of-pocket costs. I have been going to Dr. Kim Lucas (PCP) for my program. She has worked with a lot of Dr. Blackstone's patients and is bariatric-friendly. Let me know if you would like her contact info. I would recommend starting out right away with going to the SBC support groups. It will most likely be a requirement of your insurance and you will gain a lot of valuable information from the post-ops who have not only battled through the insurance challenges but have first-hand experience with the positive and negative aspects of the surgery. I have some great information that I have collected from others on this website including a summary sheet to have your PCP sign during your monthly visit, etc. Please let me know if you would like any additional info/documents and please feel free to email me back with any questions. I hope this info helps. Best wishes, Sandi 1. Documentation of 5 years history of severe obesity 2. Documentation of 6 consecutive months participation in a physician-supervised weight loss program (including monthly weigh-ins, nutritional analysis, education and at least monthly encounters with a health professional) documented by a physician who does not perform weight loss surgery, within the past year. 3. The weight loss program should include all of the following physician-directed components: ? Dietary therapy & increased physical activity ? Behavioral therapy to reinforce dietary therapy and increased physical activity ? Consideration of pharmacotherapy with FDA-approved weight loss drugs Must include ALL of the following: 1. Psychiatric assessment and approval 2. Medical assessment and approval 3. Nutritional Counseling 4. Exercise Counseling 5. Psychological Counseling (licensed practitioner) 6. Support Group Meetings Diet programs/plans alone, such as Weigh****chers®, Jenny Craig®, or similar plans, are not considered physician-directed weight loss programs. Physician-directed programs consisting exclusively of pharmacological management are also not considered physician-directed programs. Documentation from the medical records indicating that consistent reason-able efforts have been made by a physician to manage the co-morbidities using standard medical protocols. Inadequate treatment of a co-morbid condition should not be used as an indication for gastric bypass surgery in those patients with BMI's between 35 and 39.9. 4. Coverage is provided at In-Network providers only. Network vendors are to scrutinize providers. 5. Criteria: 100% overweight (ideal body and/or twice ideal body weight) with a BMI of 40 with clinically serious medical condition of obesity: life threatening cardio-pulmonary problems such as: hypoventilation, severe sleep apnea, Pickwickian syndrome and obese related cardiomyopathy, clinically unmanageable diabetes, hypertension, life threatening cardiomyopathy problems, coronary artery disease, obesity related pulmonary hypertension. 6. Age: must be between 18 and 55 years of age. 7. All patients should undergo careful selection after evaluation by a multidisciplinary team including documented medical, psychological & nutritional evaluation. A pt should be acquainted with nutritional needs & the physiologic & behavioral changes necessitated by the surgery, as documented by a physician or healthcare professional. ? Primary Care Physician (PCP): each candidate must have a primary care physician, a physician who practices in the community in which the prospective patient resides. That PCP must perform a physical examination on the prospective candidate for weight loss surgery, and provide written verification of (1) the examination and findings; (2) that the prospective candidate is medically stable and able to withstand surgery, and (3) agree to provide follow-up care after the surgery. Psychological Preparation: If the prospective candidate is under the care of a licensed mental health professional, that professional must provide a written verification that (1) he/she is treating the prospective candidate; (2) agreement that wt loss surgery is appropriate for the prospective candidate. Each prospective candidate must pass standard psychological screening test (such as MMPI).

Rebecca, I know you posted this a while ago, but my friend just got approved through Ran+Amn and is a state employee. She has waited 7 years, so it is possible. Just make sure you dot every I and cross every T. You ususally cannot get by the 6 month diet, I tried with Cigna and United, so you have to do that part. 4 weeks apart for weigh in's and no longer between appointments or they can get you on a technicality. Deanne Dr. Blackstone 11/9/04 Ps. Is this the Rebecca from Chrysalis?

Deanne...thanks for the info. I am meeting with my doctor to start the 6 month diet next week and am really excited to get going. And yes...I did attend a Chrysalis oh about 10 years ago or so. Rebecca