Anyone have Priority Health?

Greetings all. I'm just wondering if anyone has Priority Health. I am waiting now for approval for the next stage to consult with a surgeon and do the other testing. The waiting is killing me, but I know that most people that are waiting feel this way. I'm just wondering if any of you have dealt with Priority Health. If so, what was your experience like? Thanks so much. Nikki

Hi! Priority Health has been AWESOME!  AND FAST!!!  My doctor sent the letter and medical records from my 3 years of medical weight loss.  My BMI is 42.  PH received them on Christmas Eve.  I knew New Years eve. that I was approved for my surgical evaluation.  I found out because I called PH and asked to check on the status of my authorization.  The lady on the phone asked for my ins. #'s and voila!!!  "Yes, you have been authorized for a surgical evaluation.  Would you like your authorization number?"   I started shaking and could barely find a pen in my purse.  I was truly ready to have to fight but I met all the criteria.  BMI >40, medical program completed, and sleep apnea with AHI>10, mine is 14.  I have not read any bad postings LATELY about PH.  I think since they changed their policy and have started to just cover it if you meet the criteria instead of fighting you it has gone well.   I have been told (not sure if it's accurate) that 99% of the time if your surgical eval. is covered you get authorized for surgery.  Now, this gives me a lot of hope but I am trying not to get my hopes up too high.   I have my consult on the 31st and will post after I find out about my authorization for surgery. Best of luck with your phone call :-) Let me know if you find out more.

Thanks so much Laura. I am going to hold on to your story for hope. My BMI is well over 50, so I know that I am waived from the medically supervised plan. Also, if your BMI is over 50, you don't need to have any comorbidities...which I am fortunate not to have. At this point, my knee and back just hurts....

I am going to try to be patient. The waiting is not easy.

Good luck on your consult. Please let me know how it went.  Nikki

 

I had priority also.......but  I had to go through the six month weight loss program, which I was upset at the time but now realize I got a wonderful education on nutrition that  I can now use after WLS. I really have no complaints about them. Patience is a big part of this whole journey. I had surgery Jan.16, 08 and it was a year to the month that I began this road. I wish you the best.....it will all be worth the wait. colleen

Thanks so much. Best wishes to you now that you are on the loser's bench.

Nikki, When was your paperwork turned in?  You should be authorized with no problems according to the policy!!!  Seriously--they are pretty fast.  If 4business days have passed I would not hesitate to call PH.  I have always had polite service when calling.  Can you tell I'm excited for you???? I'll keep you posted. Have a good one,

The letter from my PCP was faxed to PH on 1/9/08. It is now 1/23 and I just called PH and I was told that she "didn't see anything in the system."  I was not very happy, as I've been calling every other day, and I was being told that the authorization was "pending".  So I called my PCP's office to have them re-fax the letter to PH today. It is so frustrating because I feel like so much of it is all out of my hands. I have to just trust that everyone will do what they are supposed to do in order to get the ball rolling. The customer service rep that I talked to told me that there should be something in the system by now if it was sent over the week of Jan 7th.  Now all my PCP sent was the letter recommending me for the surgery and nothing else. I wonder if that's the problem? Since my BMI is 57, I didn't need any medically supervised WL plan or any comorbidities. Oh....the agony

Be persistent about this paperwork.........you have to be your own advocate about his whole thing.....otherwise it may move like a darn turtle. The best to you, colleen

Nikki, I agree with Colleen.  You need to follow up on EVERYTHING!!  I would call tomorrow and see if PH got the fax.  Get to  know someone by first name in your doctor's medical records dept.  Ask for him/her each time you call.  Hopefully you don't need to anymore. Good Luck and keep us posted

Thank you so much for the advice. I am going to be persistent. I will keep you posted. Have a great day. Nikki