HAP HMO- new insurance changes- i am now denied-- please help!

Hi there- Readers Digest version is this-- HAP had it as a benefit a week ago for the surgery and i could use my weigh****chers weigh in booklets as my supervised weight loss efforts-- saw my PCP, have my PSY eval. this week and now they are telling me i have to go to beaumont or henry ford for ONE YEAR on their weight loss program... This new rule became effective the first of this year.. anyone else running into problems like this? My BMI is 42- do you think it would be helpful to put in an appeal letter? I have my heart set on the surgery and to have the rug pulled out from me like that is really a horrible thing to go through... any suggestions would really be appreciated...

Do you already have your approval letter to do the psych eval already? If you already have an approval I do not think you have to worry. Or did you get a letter stating you are denied? You cannot appeal until you are denied. Do you have any co-morbidities? I have HAP for the last 10 years and absolutely love it, I know I am the minority on those feelings. I had my surgery before it was even a benefit, so you can appeal if you were denied, but just be persistant and keep a level head. Meanwhile, get into a weight loss program because ultimately it will help. I had my surgery at Henry Ford. E-mail me with any questions. Carol

I used my Weigh****cher charts to help with my case. Would you believe they were from 1999?? Fight them on this one...

Kate, I saw my PCP on Jan 9 and she said they do accept Weigh****chers or the WOW program at HFH. Hmmm, I will have to call now and find out which it is. I don't think HAP covers it either way though, which makes it financially difficult for me to even participate. Keep us posted!

I have HAP and just had my surgery at Henry Ford in Oct. Did HAP tell you that you had to join Henry Ford or Beaumont for a one year weight loss program or did your PCP tell you that? I was told the same thing when I first started applying for surgery but since I had co-morbidities they didn't require it. If you have an appointment for your Psych eval. then it seems to me that you have been approved. HAP doesn't cover any of these appointments until they give you an approval number. If you have co-morbidities then I would appeal. I'd be glad to help you out with any other info that you need. Good Luck! Kitty

HAP are the ones who told me I have to have this... but the thing is... I am part of the DMC so i can participate with CORI- but they want me to go out of network to Beaumont or Henry Ford for the ONE YEAR of their wight loss program... that is just plain crazy... i have sent for an appeal packet which should be coming to me in the next week-- does anyone out there have copies off any/all letters they sent in for their appeal that were eventually approved?? I'm not too sure as to what I should include in my letter.. any help or further suggestions would be really appreciated... i have my Psy Eval on Monday- anything for me to NOT do?? lol... thanks again Kate