Priority Health & Doctors

I have 2 friends who need some help.   They both were turned down for surgery by Priority Health.  Does anyone have any experience with PH?  Should they just appeal?  Also, their primary care physicians weren't very supportive.  Does anyone know of wls friendly doctors in the Grand Rapids area that maybe they should switch to?  Thanks in advance for your help. Pat

They would probally have to go through the appeals process but if there pcp will not send in the requested documentation and the letter for WLS then they will be denied.  MMPC have pcp physcians which are wls friendly since they have the wls program.  Tricia

PH is a PITA to work with.  They consistently and constantly deny this surgery. Pam Zelenko is a PCP that is WLS friendly.

WOW, I wonder what the deal is. I know that PH is requiring more PCP documentation. I work with almost all PH people and no one, that I know, who has submitted for WLS has been denied. My bariatric surgeon's RMA, Gwen, says she knows who to talk with at PH about approvals....

Sorry to hear about all of their trouble.  I have PH and it was a breeze.  Paperwork submitted one day and 2 days later I was approved.  It also helps my BMI is high, and I have several co-morbities.  But never the less...I was not denied.  AND if I was denied, I would appeal once, maybe twice.. then I would have been a selfpay.  Yeah, its a lot of money.. but I feel as if I desprately needed it. Well does not matter anymore.. I have a date of October three I will be thinking about your 2 friends.  Please tell them to get another PCP one that will comply.  This is a tool that some people need to go on.  I dont have any suggestions as I live south of GR, but I wish them all the luck... Jodi :O)

Pat, I have PH and I also had trouble getting surgery approved as they required me to complete the Medical Weight Loss program at MMPC twice--which i couldn't do as I couldn't tolerate the product. One of my specialists really got things moving when he became as frustrated as I did. My advice is that if your friends have co-morbidities then they should get a letter from each one of them recommending surgery along with their PCP. If their PCP is not supportive, then maybe they should change as this is done for their health afterall!  I live in GR (but my PCP is in Rockford). If they want a PCP who is pro-WLS they may want to see one of the Internists who also work at the MMPC's weight loss clinic (such as VanDyken, White...). Let me know if you have any other questions and I'll try to help. Good luck.

Hi, my PCP is also very unsupportive with respect to wls, and I'm looking for a good doctor in the West Bloomfield / Farmington / Commerce / Southfield area...Can anyone help please??? Thanks, Xena