PHP bariatric surgeries covered?

Hi..

I was just wondering if anyone knows what type of surgeries PHP of Mid Michigan covers?  I looked over their information today and didn't see where it specified which it would cover.  I am not a fan of the RNY if I were I'd of had the surgery years ago.  The lap band is ok, but not what I would prefer either given my high BMI and the huge amount I have to lose.  I had alway thought the DS was the way to go but then was introduced to the vsg a while back and given all info I have on it verses the other surgery it seems to be what I'm looking for.  I guess I can call Saprrow Weight management tomorrow as I'm sure they have the answer to this question.  

TIA for any answers! 
Paula

Good Luck Paula.  I hope you can get the surgery you want covered by your insurance.  I had HAP at the time and it would only cover the Lap Band or RNY.  I chose RNY and am very very very happy with it.  No complaints whatsoever at this point.
Jan

Paula -
I have the php guidelines in a form they sent me.  It says they cover:

Vertical Banded Gastroplasty
Roux-en=y gastric bypass
laparosopic or pen surgical, gastric restrictive procedure

there are a bunch of code numbers - if you know the code number for the specific surgery you want, I can look and see if its on this list.

typo : laparoscopic or OPEN surgical...

Thanks.. .a quick search came up with the code 43775 not sure if that is correct or not.. I know that Sparrows weight managment (who PHP uses) does not use the VBG but they do the VSG so maybe I'll be in luck! 

Thanks,
Paula

That code was not on my list....I would say call php in the morning - make sure you document who you spoke to, etc.  when I called them Friday, I got a really nice rep.  Whom I'll be bugging tomorrow with more questions :)

Maybe its possible that if Sparrow does not provide the kind you need, php would allow you special cir****tances and cover you to go elsewhere.  Might be worth asking?

My suggestion would be to call your insurance and ask that they send their critera required for WLS and which surgeries are covered by your policy. Different employers pay for different types of coverage and some exclude WLS from their policies.


Good Luck.

Hi...

For those interested.. I called Sparrow Weight Management who suggested I call the insurance company.  The insurance company was like what?!?!  They should know what we cover since we use their guidelines..   She informed me that if it is a surgery they preform and one of the Dr's there suggested it to me (which they did)  that it would most likely be approved.  That each and every case has to go in for review and they basically do waht SWM (sparrow weight management) suggests they do.  So I am more hopeful in going to the meeting on the 26th!! 

Paula

Most Likely ?  I'd be leary of that reply.  I'd want a definitive yes or no and get it in writing.  Too many people have been screwed by their insurance companies.
Jan

some times you can go to your ins on line and look up your policy and see what it says about Wls. and what is covered and the criteria too.