Help?

I need your guys help. My cousin is looking into getting gastric bypass in Arizona but he has Ahccs. Has anyone recently had surgery approved by either APIPA or Mercy Care? Please let me know, he's only 29 y/o and weights over 400 lbs, and me having had the surgery myself know he can benefit from it. He's just too shy to ask around so I'll do it for him. Thank you .

Mercy care requires jumping through a lot of hoops, so he has to give up the shyness to some extent and become a bit of a pit bull to get this surgery. The state does cover it, but will use every excuse to deny or stall in order to thwart you and save money. He needs to first, write Mercy Care a formal letter asking for the requirements for surgery and back that up with calls if they don't get back to him promptly. He also needs to go to his PC and get a letter of recommendation for the surgery and referrals to document all of his co-morbidities. He needs to get on an immediate doctor supervised diet as well. I believe they require a certain percentage of weight loss in order to approve. I recommend going to Dr. Juarez's seminar. I know he accepts Mercy Care and his office also has a sheet of do's and don'ts for how to get coverage through AHCCS. One big hurdle can be the psych evaluation. Have him study up on exactly what they're looking for in a psych eval and try to find a WLS friendly psychologist who takes AHCCS. That can be easier said than done, but maybe someone on this board or on a local Weight Loss Surgery Board where you are can give you a name.. He needs to dot his I s and cross those Ts, but he can get it. Good luck. - Stephanie J

Hi Christine, It is my understanding that Dr. Juarez and Dr. Alan Newhoff both take ACCHCS. There are many new surgeons in the Phoenix area so perhaps there are others who do, too. You can find their names on this Board. My suggestion is this and in this order: #1 Call several surgeons and talk to their office managers. That person can send your cousin all of the paperwork he needs to get started. When the manager knows that he lives out of state, she can tell him what he needs to do about the doctor seminars and the distance he would have to travel. Dr. Juarez works out of St. Luke's where they have the Bridges Center and lots of prerequisites. Dr. Newhoff works out of Banner Good Samaritan. They have a new bariatric teaching center. I don't know what their requirements are or if Dr. Newhoff uses them. The surgeon's offices usually handle all insurance matters for us. I know someone who toggled between Drs. Juarez and Newhoff because they both took ACCHCS. She finally chose Dr. Newhoff. #2 Your cousin needs to go to his PCP right away and get weighed in and documented so that the doctor can chart his weight over the next six months. His insurance may ask for it or they might not, but he needs to be prepared. A lot of us on this board have learned that the insurance companies like to ask for this at the last minute and without warning. Best to be prepared. #3 After that research, research, research. You have to be proactive and assertive to get this surgery. One year of pre-op work is not unusual. Hope this helps. You may get a lot of suggestions to your post. Read them and learn. This is not a "one size fits all" kind of journey. Good luck to you and your cousin. Fran Baseden #4

Your cousin should call APIPA/Ahccs and ask what his policy covers. There are many policies under ahcces, so asking the insurance co first should be his first step. Or you can call for him - make sure you have his policy number when you call. They may only give info out for his policy only to him, so be prepared for that. Here are some helpful links you can check out today: http://www.obesityhelp.com/morbidobesity/bariatric+surgery+insurers+in+arizona.html http://www.doctorsimpson.com/insurance.php http://www.obesityhelp.com/morbidobesity/mdcomments.php?N=K149 (scroll down for insurance links) http://obesityhelp.com/morbidobesity/bariatric+surgeon+profile+Hilario+Juarez+crp.html (scroll down for insurance links) http://www.obesityhelp.com/morbidobesity/forums/insurance.phtml?ID=A-J2 You are great to help your cousin out on this!! It can be quite overwhelming with all the hoops we have to jump through for insurance companies. Trisha