Anyone have experience with Harvard Pilgrim PPO

cpower100
on 7/25/14 5:15 am

I have seen a lot of posts about BCBS but none about Harvard Pilgrim.  I am wondering what experiences others have had with RNY approval if you meet the BMI of 40 requirement.  Trying to figure out what my turn around time will be.  

Capegin
on 8/6/14 11:04 pm

Hi!  I don't think I have the PPO plan at Harvard Pilgrim, but I do have Harvard Pilgrim.  I got approved pretty quickly for VSG, and I was sweating it because I thought I was iffy on hitting the requirements.  My official BMI, based on the surgeon's scale, was 39.7, and I have zero other health problems.  I do have a history of documented, supervised weight loss attempts, so I don't know if that helped.  I started the process on May 20th with my first appointment with the surgeon, and I'm having surgery on August 13th.  The lag time actually had nothing to do with insurance; it was just waiting for appointments to see the specialists. Some of them were pretty booked, so I had to wait for a month to get in.  I had my final consult with the surgeon on a Monday, which is when the office submitted my application to insurance, and I had a surgery date the next week.  My understanding is Harvard Pilgrim is notoriously fast with the turn around!

Good luck to you!

Grim_Traveller
on 8/7/14 12:18 pm
RNY on 08/21/12

I had Harvard Pilgrim PPO, state employee plan. I had no problems, approval was very quick.

6'3" tall, male.

Highest weight was 475. RNY on 08/21/12. Current weight: 198.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

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