Priority Health HMO??

Priority Health sent me a letter last week telling me that they had approved me for the weight loss program through Munson Medical Center. Priority Health has you go through this program for 6 months. I just wanted to know if anyone else has had to go through this and if so were they ever approved for WLS?? Please let me know. thanks christine s.

Christine, Priority Health HMO also wanted me to go on there Weight loss program for 6 month. My doctor called and ask if she could help with all this process and they decided to let me be evaluated. I was in November that I seen Dr. Baker and I just got approval for surgery in December. Now I'm going thru all the appointments for the surgery and of course I have something going on with all of them. I had my last one yesterday. Maybe in the near future I will get a surgery date. I'm a diabetic and have other problems and medical needs. I hope this will help but It isn't and easy process. The weight loss program is very costly. Best of Luck. Viva

Hi Viva, Thanks for your post. I too am a type one diabectic and have been since age 10. I thought about asking both my family doctor and my Rheumatologist (she treats my Rheumatoid arthritis) if they would write a letter stating all of my health problems to see if they would wave the 6 mnth diet program, but I wasnt sure if it would help my case. I was under the understanding that there was really no way around their diet program. But after reading your post, I might just ask them. Guess it couldn't hurt. Keep in touch. You can reach me by email if you would like, [email protected] thanks again christine

From what I understand with Priority Health (and this may differ depending on what exclusions or riders your company has added to its policy) they require 6 months med supervised weight loss (i.e. liquid diet) if you are under 50 BMI. If you are 50 BMI or greater and have a co-morbidity, they will waive the 6 month med supervised weight loss. When I called Priority in November to find out what my coverage was, they said that they do not cover the 6 month med supervised weight loss, and it had to be done thru MMPC in Grand Rapids. I have not begun paperwork yet, as I have my PCP appt on Feb 7 to get the ball rolling, but I expect PH to be a pain to work with. Good luck. Please post what happens with this and thier decision. Tammi

Hi Tammi, the medically super. program through Munson in Traverse City charges $2400 for the 6 month program. Priority will cover all but $841 which is mostly my co-pays and a couple of other fees. I am just afraid that once I go through this program that P. Health will deny me for WLS. They were really quick in approving me for this program, it only took them two days to fax back that approval to my PCP. I am just not sure what to expect after these 6 months. I also found out that I have to pay for the first $1,000 of my surgerons fees, but in all considered that is not bad. It could always be worse. Email me if you ever want to talk at [email protected] Good luck with your journey as well, maybe next year at this time we'll be post-op and our way to being loser. christine s.