HealthEase Members

Hi there everyone, Im so sad and depressed today because Healthease changed my PCP and the people in the new PCP office dont even know what they are doing....Im so lost and dont understand how this works, one day things look like they are going great and then the next day it looks like everything is going down hill, like I just want to give up..... Can anyone that has used Healthease for there Surgery recently tell me what were there Requirements to get approved for the Surgery. I cant seem to get my PCP office to understand that I need them to call Healthease and ask them to fax over there requirements to get approved, so that I can take it with me to Dr. Murr's office on Jan 6th because Susan said that they need 12 months recorded diet history and my old PCP the one that I started this Journey called Healthease and they told that office I needed 6 months, this thing is so screwed up that I just want to curl up in a ball and cry.......the only good thing that happened was that the Surgeons office called and moved up my appointment from the 13 to the 6th of Jan. woooo hoooo on that part.....so can someone please help me out here so that I wont give up.....hugs Maria

Maria, with my dealings with Humana I can only suggest YOU call Healthease and get the requirement straight from them and have them Send or fax or tell you where on the Web you can print their requirement out. If their requiring the 12 months your doctor is just wasting your time by pushing for 6 months. I had been see doctors for years while doing Weigh****chers for four years and my doctors knew this but none of them documented it. So I'm on my third of the required 6 months Humana requires. There's no way around it. I see Dr.Rehnke once a month to get weighed and thus from there both my surgeon & my PCP are documenting my progress. But there's another hump in my insurance. Their stating in written documents that if I lose more than ten percent of my initial BMI at the start of this diet (about 50 pounds) that they'll deny me stating I should just continue the diet to lose weight without the surgery. Good Luck , Oh and get copies of everything so you will your own records too and not depend on others who tend to lose documentations. Mike

Hi, I have Healthease but I used Dr. Rehnke in St. Pete for my surgery. Here's a list of what healthease requires: 1-Medical records for the past 2yrs showing dates and weights documented by your pcp. 2-Documentation of failed attempts with supervised weight-reduction programs for 18 months.(low or very low calorie diet, supervised exercise behavior modification, support or drug therapy) 3-Medical records outlining current health from all doctors(pcp, orthopaedic, gyn. etc) 4-Evidence of emotional stability-psychological evaluation. I had to have chest xrays, blood work, ekg and a hpylori test done. I had some done twice only because my pcp had me do them to soon before getting approval for surgery, you also have to have a medically necessary letter written by your pcp( i had my pcp and orthopaedic write one for me). I also had to have a clearance letter from my pcp within the week before my surgery. If you have any questions just ask and good luck on your wl journey. Tammy