ins approval..anyone have PPK?

I'm just beginning the research and am wondering if any has had approval from PPK in Wichita?

Trish, I have not seen a PPK policy that has coverage for WLS. It will depend on who the emplyer is and how big of a company. If it is an employer with less that 50 lives, it will not be covered.

it is thru General Electric. They paid for a tummy tuck that i needed due to a spider bite debridement that needed to be done, so I'm hoping that if they would pay for something like that, I can get this thru! lol

I would suggest that you ask the HR department for a copy of the certificate of coverage. Then I would read it front to back and find out how they cover the procedure. With it being through GE you should be okay. You can always call PPK and ask, but I would want to read the certificate myself. Good luck and best wishes.

Trish, I have PPK. Through Spirit Aero systems. I am going through Solutions For Life, Dr. Early's program. I did call before I even went to the orientation meeting and was told that they did not cover WLS. Kate( with SFL), at the meeting said they did. Called PPK back the next day and they said if I had seen my PCP for 6 consecutive months for a weight loss program they would cover the surgery. That was Aug of 2006. So I did. During that time I went through the SFL program, had all required tests and appointments done and paid all my fees. PPK will cover some of the fees, you have to have the work done through your PCP. (blood work, mammogram, sleep study, and others) At least this is my story. I know it can be different for different people. Anyway, all my I's were dotted and my T's were crossed, with the exception of the letter my PCP wrote at the end of my 6 month weight loss appointments.( Feb 2007) I had my own copy and questioned the wording of it. Was told SFL would go ahead and send it in and see what happens. I was initially denied. It went through three others at PPK before getting to the top and then Dr. Early intervened and was able to talk them into a "new" set of criteria. They gave me three months to meet this and then will re-evaluate. I am 3 pounds from the weight loss required and have been told they will approve me once this is done. That will be the first week of June. So I would tell you based on my experience, to document, document, document, and keep copies of EVERYTHING. The doctors are good about that. I never had a problem getting copies of anything. And I was glad I did. I needed them almost every time. Be sure to document names, times and dates when you talk with PPK. I found this made all the difference.

i did get them to send me a copy of the certificate and it says "if you have complied with more conservative treatments, you can have your dr initiate the prior authorization process to determine if you meet the criteria for coverage" #4. Surgical treatment and all services related to such treatment of obesity and weight reduction, unless the Member has complied with more conservative treatments. so this is basically what you are dealing with? I work in the insurance claims industry and our rules are "if it doesn't specifically exclude it, then it's covered"...lol

I sell health insurance and have filed several claims to get things covered before. It looks like from what you have found out, that it is covered. Now all you have to do is find out what hoops you have to jump through to get them to pay for it. I agree that you have to keep track of everyone you talk to. Get names and numbers and include the time and dates in your records. Do not give up and do not get discouraged. It can be done. Don't be afraid to ask for help. Good luck and best wishes.

It does sound like the wording is the same. Like I said, at first it was that they wanted me to be seen by my PCP for 6 consecutive months, but I had a weight gain and that along with my Dr. letter I think sent up red flags. I was on the phone with them constantly. I really do think I drove them crazy. I am not sure PPK has the same rules when it comes to "if it's not specifically excluded, it's covered". It seems to me that they keep changing their criteria on me. I think it's more about the mood they are in an any given day. I have a good friend who works for a local Doc and that is her opinion.