State Employee - Schaller Anderson Insurance

Is there anyone who has had experience with Schaller Anderson approving or not approving their surgery? I'm a State of Arizona employee, and had the choice of them or United Healthcare at open enrollment last year. I think maybe I chose the wrong provider. There isn't anyone on this website from AZ who has listed any experience with them, however, Dr. Blackstone's office staff seem to feel very positive they will approve their recommendation for my surgery.

I have not heard of them and would be very happy for you if they cover your surgery. I do not undersand why the insurances are no longer covering the surgery because I beleive with out it I would have cost alot more for the company by now.. Good luck to you. God Bless Terri 303/137

I am also a state employee and was told that if I wanted the insurance to approve my surgery, I had to go with United. I did, and United said they only covered it because Cigna approved it right before we switched over. Convenient that Cigna only approved it (after two years of fighting them) when they knew they wouldn't have to pay for it. Anyway, I had my surgery in December, and at that time, Dr. Blackstone's office told me United was the only on they worked with so hopefully that has changed since then. Good luck, and Trish at Dr. Blackstone's office is awesome! If she says it will happen, I'd believe her! Good Luck!

United used to be the only one Dr. Blackstone worked with, but as of this time, Dr. Kieran is in-network with Schaller Anderson, and Dr. Blackstone will be very soon. So how are you doing since your surgery? I still don't understand how I can keep from gaining all of my weight back after I've lost it. How will I keep my old eating habits from coming back, if I couldn't before? Obviously the surgery is "just a tool," but sometimes I just don't know if I can do it.

I didn't see many Aetna insureds on this site posting recently up to my surgery and wondered the same thing. However, if the surgeon's office is confident that your insurance is OK, then you have nothing to worry about. Some United Healthcare policies took out the weight loss surgery coverage so be glad you didn't go through them. My friend had United Health Care pre-op, but found out 6 mons later that they were changing their policies. Aetna did too. In fact, Aetna took out covering weight loss surgery in 2005, however because my employer's policy didn't renew until June 1, 05, I had until then to have surgery. Yay!! Can you go to the Schller Anderson website and find out what your insurance requires? Can you call Dr. Blackstone's office and find out what the requirements are for precertification? I hope you get approved and your surgery date is soon!! Keep us posted!

I have United Healthcare, and I was turned down in December - mainly because I lacked the 6 month physician supervised diet. I'm about to finish that and I will be appealing. I had a really hard time getting the criteria list out of UHC. I believe that all of the state health insurances have similar or the same criteria since the state is self-insured and these companies are processing claims/administering the coverage. Call the ADOA if you can't get the information from Schaller Anderson. Below is what I got from UHC: Gastric Bypass Services Guidelines: Demonstrate 10% weight loss prior to auth to demonstrate commitment, per recent UCLA study. Documentation of 6 consecutive months of physician-supervised weight loss program (including monthly weigh-ins, nutritional analysis, education and at least monthly clinical encounters with a health professional) documented by a physician who does not perform weight loss surgery, within the past year. 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. *Diet programs/plans alone, such as Weigh****chers®, Jenny Craig® or similar plans, are not considered physician-directed wt loss programs. Physician-directed programs consisting exclusively of pharmacological management are also not considered physician-directed programs. Documentation from the medical record indicating that consistent reasonable efforts have been made by a physician to manage the comorbidities using standard medical protocols. Inadequate treatment of a comorbid condition should not be used as an indication for gastric bypass surgery in those patients with BMI's between 35 and 39.9. Note: 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. In Network only: Network vendors to scrutinize providers 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. Must include ALL of the following: Psychiatric assessment and approval Medical assessment and approval Nutritional Counseling Exercise Counseling Psychological Counseling (licensed practitioner) Support Group Meetings Age: must be between 18 and 65 years of age 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 prof., that prof. must provide 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). The above guidelines are subject to change based on new clinical evidence of adverse outcomes.

Thank you Gabrielle for all of the time and energy you put into this information. I appreciate it very much. This is the first time I've posted anything, and everyone who has responded has really been great!

I too am a state employee, but I didn't have state insurance, I had a federal plan, GEHA (AZ Foundation) and got approval because of my co-morbities in one day. However I have several people I know in the office that had the surgery with Dr. Blackstone, one 6 1/2 months ago and one 1 year and 3 months ago. I heard that the longest out had to go through this center and pay a lawyer (reasonable fee as I recall) to appeal. So did several of her co-workers. They all got the surgery. Just a suggestion and I hope you get approved.

My husband is a state employee and we have Schaller Anderson insurance. I am a patient at Scottsdale Bariatric too. I just sent documentation of supervised weight loss to the office. They will probably submit it in a week or so. I searched the net and found two references about Schaller Anderson re wls. Both got approved. I really have no idea what to expect.