Pekin Insurance Question-PHCS

Good Morning,

I was wondering if anyone had experience with Pekin Life Insurance Company out of Pekin, IL.  I FINALLY got insurance that will cover WLS, but with this criteria:

Surgical treatment of morbid obesity will be covered only if:
          the morbid obesity condition has persisted for at least 5 years; and
          for which nonsurgical treatment that is supervised by a physician has been unsuccessful 
          for at least 18 CONSECUTIVE months

Well Grrrrrrrrrrrrrrrr!!!!  I have been morbidly obese my ENTIRE life and that criteria is certainly NOT a problem, and I have tried EVERY diet, etc., known to mankind, BUT my physician didn't make me see him EVERY month....

Does anyone have any experience with this issue...
If you do... please get back with me and let me know how you handled it.

Thanks
TNG

Hi TNG -

I don't have any experience with Pekin Insurance (other than the fact that I've been to Pekin several times!).  However, I do know that Indiana law states that only 6 months of physician supervised weight loss attempts are required.

That being said, I don't know which is the governing factor - where the patient is, or where the insurance company is.  Perhaps someone else knows that answer?

Thanks Christie!

I appreciate that tidbit of information.  I did not know that!

Thanks a lot!
TNG

I don't have any knowledge relating to Pekin Life Insurance Co.  Every insurance is different and I don't have the answer, but I do have a suggestion.  Go ahead and submit the information you have for approval.  They just might go ahead and approve you and if they don't then you can begin the supervised treatments and go from there.

My insurance also required 6 months supervised treatment, which I did not have.  I submitted to my surgeon my list of diets I had tried over the years (including over 18 months of W.W.), my last 5 documented weights from my family physician, and a letter of recommendation from my family physician.  I was approved as soon as insurance received the paperwork even without the 6 months supervised treatments.

I also had several comorbidities like high blood pressure, asthma, pcos, etc that I made sure my doctor listed in his letter of recommendation.

Hope this helps some,
Melissa

If the insurance company does business in Indiana, tey must abide by the State's 6 months law.  They can not enfoce a medical supervision greater than 6 months.  Good luck!