new from Illinois

Hello everyone, I am new to the boards.  I enjoy reading all the great information everyone has to share.  I was just wondering if anyone has PHCS Coresource PPO.  I am an Advocate employee and haven't really been able to find out what exactly the criteria is for approval.  I am probably just being impatient, but if I new what the criteria was I would feel better knowing what I had to do.  I have type II diabetes, hypertension, high cholesterol and sleep apnea.  Just curious if anyone has any info on corsesource. Thanks, Michelle

WELCOME! Try posting your question on the Insurance Forum. Also, enter "Coresource" in the search field. I have PHCS but it's administered by PBA. Here's what's required: *Must be obese for at least five years *BMI must be greater than 40 *2-3 (at least six months) weight loss attempts ... supervised by doctor, nutrition, or exercise regime for three years. Contact your provider and tell them to mail you a copy of their requirements.

Thank you. I will post that.  I have called the insurance company and after being transferred a few times, was told I needed a letter of medical necessity filled out by the surgeon, which was done on 5/20.  As for the criteria that seems to be the big secret lol.  Thank you very much for your input. 

Dear Michelle: I do not have that insurance so I can not help you there, although you've gotten a great answer already. I just wanted to welcome you to the board, and hope to get to know you better.  Drop in on the roll call.  That is where we share our daily lives.

Hi Michelle, welcome t othe Illinois Board. I think its the greatest on OH. Anyway, I do not have your insurance, but I would start by calling them and asking for whoever takes care of WLS. She/He would be the one that knows what you need.  and as Dawn said, please join us on our daily roll call.

Just got doen dealing with Coresource PHCS. Besides the letter of medical, you will need a Phsycological and Nutirional Assesment. If accepted about 2 weeks time. Harry

Thanks Harry! I appreciate the information.   Michelle

Hey Michelle, There is a lady on the board who is great with insurance, just go to her profile and send her a message... cutiedoll58 I didn't have to mess with insurance my doctors office did all of that for me, thank god! Lynne

Thanks Lynne! I will give that a try.  The doctors office is doing pretty much everything, but my insurance wasn't really clear on what criteria had to be met.  The last time I spoke to them they said it was based on each individual.  So I guess I pretty much have to wait and see.  I hope it comes soon!   Michelle