STAYWELL

Does anyone have any experience with Staywell Insurance? They won't tell me anything about what their policy is for WLS. They told me that so long as it is medically necessary..so I asked for the definition of "medically necessary"..they said the only ones that know that are the authorization dept..and they dont speak to patients..only doctors.. AMAZING!!!! Any info you guys can provide would be a great help!!! Thanks, Jen

I HAVE STAYWELL MEDICADE I HAD MY APPT.WITH THE SURGON 2 WEEKS AGO AND I BELIEVE MY PAPER WORK WAS SENT TO STAYWELL SOME TIME THIS WEEK.THEY TOLD ME IT USUALLY TAKES 2 WEEKS FOR ANSWER AND ASLONG AS IT IS MEDICALLY NECESSARY IT WOULD GET APPROVED SO NOW IM JUST PRAYING TO GOD THAT I GET APPROVED.I HAVE BEEN RESEARCHING WLS FOR A WHILE AND DONT SEE HARDLY ANY ONE THAT HAS GOTTEN APPROVED THREW STAYWELL..SO WE SHALL SEE

Jen- I don't have Staywell...but I can tell you that my insurance considers medically necessary as a BMI over 40. And they also consider some just under 40 with several co-morbidities. And the patient has to have tried to loose the weight several other ways. Co morbidities would be things like- Diabetes, high blood pressure, sleep apnea, back problems, knee problems,.... Also, try calling again. Sometimes different reps will give different amounts of information. Tell them you have a right to know if this is covered- so they need to define medically necessary! (even if THEY have to call the other department and ask!) Good luck! Linda

Hi Jen, somebody just had surgery in May through Dr Haicken in Largo who had Staywell, I also have staywell and am just waiting for my approval...it doesn't matter who you call or who you speak to at Staywell you will get the same answer as you got...I have called them about 13 times and got the same answer...but they have and they do cover WLS you just have to find the right surgeon that accepts it and knows how to word the paperwork when it gets to them to get approved...good luck on your search... April

Hello Jen, I have Healthease-Medicade and I had to have medically necessary and a diet profile from my PHP for at least six months. Michele

Thanks for the info everyone. It is very helpful. I set up my consult w/ Dr. Haicken for August 18th so I could go to the support group meeting first but I don't think I'm going to be able to go that Saturday so I may call and reschedule my consult for earlier b/c I just can't wait lol.