State of AZ Employees

Hello, if there are any State of Arizona employees trying to get WLS please post. I have UHC and found out what it takes to get approved. If you have another insurance that is easier or better let us know. ,

I'm a state employee with UHC and I was approved. Here are the official guidelines, which I received from the UHC rep at ADOA: 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.

By the way, you don't have to lose the 10% within the 6 months. I didn't - it took me another month or so to get there.

WOW thanks for the info that was alot. Thank God you were out there listening and posted the info. Now about the 10% please explain how you were able to get approved without the 10%. I recently read someone elses post that they were turned down. They posted in the Dr. Blackstone's Patient Forum maybe you can help them. I have three extreme mobidities diabetes, HBP, and slep apena. Dr. Blackstone's office said they were going to submit my paperwork as is but not to expect approval this time. I meet and exceed the basic criteria but I need to loose the 10%.

Sorry, I guess I was not clear - I did lose 10%. I just didn't do it within the 6 month supervised program. I'll check the SBC patient forum and see if I can help this other person.

I am still unclear about what your saying about the 10%. Are you saying you lost the 10% in less than the six months? If so, how did you loose it?

No, it took longer than 6 months - about 7 or so. I did a modified Atkins, basically, plus Dr. Emershad at Scottsdale Bariatric Center prescribed both Phentermine (appetite suppressant) and Xenical (reduces fat digested).

Gabby, Please keep in touch with me. I am using you as my model. Which surgery are you going to do the RNY or the Band? Did I hear you correctly that you are also seeing a doctor at Scottsdale Bariatrics, too? Maybe when I go back they might put me on some of those meds. StangoDango

I am having Lap RNY on Thursday with Dr. Kieran at SBC. If you're talking about the 6 month supervised diet, yes, I was seeing Dr. Emershad at SBC for that. Gabrielle (I don't go by Gabby )

My husband is a state employee, so I am on the plan too. Because we are rural we had no choice but to take RanAm (Schaller Anderson). They said basically the same thing.