PLS HELP MIAMI/FT LAUDERDALE AREA

i need help! Everytime I get good news someone bursts my bubble. Our company recently changed insurance companies to Neighborhood Health Partnership. I was told by the agent that WLS was covered if medically necessary. I just contacted Dr. Nestor De La Cruz and someone in the office told me none of the Neighborhood insurance plans cover WLS.

I called NHP and they told me that it's not excluded but it's not a guaranteed option. It all depends on what is submitted. Does anyone know or have experience with NHP?  Next is a doctor. Obviously De La Cruz is not an option and I contacted Cleveland Clinic and I have to first attend a seminar and then get an appt.  I am at the point where I cannot stay standing for more than 5 minutes and only getting worse and that's just one of many problems. I need to find a good decent experienced doctor that can help me. Tks Cory

Have you tried US Bariatric in Fort Lauderdale? South Miami Hospital and Mercy Hospital in Miami both have bariatric centers....maybe you could contact them to get the name of a physician. I don't have experience with NHP but your surgeon will hopefully present your case well.  I had United Health Care & my BMI was less than 40.  My surgeon presented my case successfully to the insurance carrier. I used US Bariatric in Fort Lauderdale. Best of luck.....hope you are having a sunny day!      luvitsunnyv

Thanks for the response. I haven't tried them. I will def call tomorrow.  I got the impression from the NHP agent I spoke to that it all depends on what is submitted. That's why I need someone that is experienced and knows what to do. 

i have not had experience with nhp... but rosenthal at cleveland clinic did my surgery... hes great!

I 2nd the motion on Rosenthal. Please call Anita Houle @ Dr Raul Rosenthal's office. She's the insurance cordinator. 954-659-5232. Good luck!

Thanks for the info! I will definitely call tomorrow. I need someone with experience that can help me.

Count me in as suggesting Dr. Rosenthal at the Cleveland Clinic.  I am pre-op and as of this morning, have completed all of the required pre-ops. I hope to have a date soon.  Everyone I have dealt with has been super. Good luck to you! Stacey

Why not call the insurance company again and ask for a referral.

actually I called Anita at Cleveland Clinic and she was on vacation but I spoke to Marie and she confirmed that NHP does not cover WLS. I told her that our agent and the insurance company advised it all depends on the case but she had a patient get denied last month. Since NHP was purchased by United Health and it's supposed to adopt United's benefits she suggested I verify with my agent. So I asked my HR coord to verify everything and let me know.

Hey,

I wanted to also suggest the Miami Hope Center with Dr. Jorge Rabaza. I am in the process of getting the last of my paperwork together and getting it sent to my insuarance. I have met with a few people on this website that were post op and they are really happy with him. Also, his staff is amazing and Cristina Prado (surgery coordinator) is very helpful and great at working with insurance companies. I would look him up and maybe talk to his office. Good luck, I know how you feel. I am nervous as well.

Take Care and think postive, That is most important