ASR INSURANCE

Please help...if you have any experience with ASR PPOM insurance I would love to know what your experience has been...my file has just been faxed and I spoke w/the insurance co. asking how long it takes for approval and she said her experience is 4-12 months...can this be right??? Please let me know what you know! Thanks...

Stacey, I don't have ASR but I clicked on the INSURERS link to your left and went to page 4. Here is what others have reported: Insurer Policy ASR Insurer Status Denied after first letter (02/10/00) MD-supervised programs 1 (1 weeks) Source Philip Garcia Insurer Policy ASR (PPO) Insurer Status Approved after appeal letter (May 1, 2001) Surgery Type Laparoscopic RNY Weeks to approval 28 MD-supervised programs 1 (24 weeks) Comorbidities Sleep Apnea, Hypertension, GERD, Policy Must be medically necessary Comments Keep in mind that ASR is an Administrator only of self-funded plans (I hope I am saying that correctly). The business I work for has self-funded insurance (they pay all the bills) and ASR administers the claims. So, the policy of your company really dictates whether or not it will be approved, not ASR. My company recently revised its plan to include WLS ONLY if it is medically necessary, and that you can show you have tried other medically supervised weight loss plans and that they have failed. Overall, with the exception of not being terribly friendly when called on for updates, the company was easy to deal with and didn't give me too much trouble. Just be prepared that it may take a while. From my first visit to the doctor to my approval it was almost seven months to the day. (That included being denied and appealing). Source Jill Ver Lee Insurer Policy ASR (POS 100) Insurer Status Approved after first letter (06/24/00) Weeks to approval 16 Comorbidities joint pain, shortness of breath. Policy Must be medically necessary Comments I had my initial consultation in Jan. of 2000. After about two months without hearing anything I decided to call them. They didn't give me much information. Right before three months had gone by I got a letter stating that I had to prove that it was not a pre existing condition. So I went to my doctor and filled out the necessary forms. Then they told me that they needed all of my medical records from the past five years. That took a week because I had moved and had to get the records from Cadillac. Finally I had all of my information to them and then I waited, and waited. I must have bugged the insurance ajuster about a million times. . . but she was at least nice to me. Finally after about 4 months of total waiting I got approved. My advice to anyone trying to deal with ASR is to make sure you have all the information in advance so you don't have to wait so long. Also, make sure you call them, because they never called me until after I bothered them. ASR will cover this surgery if you are morbidly obese, have co-morbidities, and have documentation of previous weight loss attempts. Good Luck! Source Michelle West Insurer Policy ASR (PPOM) Insurer Status Approved after first letter (01/14/01) Surgery Type Open RNY Weeks to approval 8 Policy Must be medically necessary Comments I didn't have to do much. Amy from Dr. Scholten's office sent in the original paper work. I received a letter that thay needed additonal medical necessity and weight loss history. I went to my PCP, he wrote a letter and then just waited to hear something. I did call a couple times to check on the status and was told I'd hear by mail within 2 to 3 weeks. It was 3 weeks and one day that I received a call from Amy at Dr. Scholten's office that I was approved. I'm still waiting for the letter in the mail! That was last week. In all from the time I saw Dr. Scholten for consult to the time I received a call that I was approved it was about 8 weeks. Source Susan Fortune Insurer Policy ASR (PPO) Insurer Status Approved after first letter (03/02/02) Surgery Type Laparoscopic RNY - proximal MD-supervised programs 1 (18 weeks) Source Maggie Cole Insurer Policy ASR (PPOM) Insurer Status Approved after first letter (03/26/01) Surgery Type Open RNY MD-supervised programs 2 (16 weeks) Source Danielle Hoonhorst Insurer Policy ASR (Physicians care) Insurer Status Approved after first letter (10/12/01) Surgery Type Open RNY - proximal Pre-Op BMI 56.6 Comorbidities Arthritis, insulin dependant diabetes, diabetic neuropathy, degenerative disk, GERD, depression, Policy Must be medically necessary Comments I spoke with Heidi yesterday and she was very helpful and invited me to call whenever I had questions. She explained that bariatric decisions are made by a panel of dr. and nurses not by ASR itself. She told me once they received the medical records and letter of medical necessity it usually takes about a month. BTC, however, didn't inform me that this information was needed until a month after my 1st consultation. I am checking today with my PCP to see if they have sent the paperwork that I requested last Wed. ASR is an admisitrator. Our policy required a review by a nursing group, an ASR supervisor, and a board of doctors to be determined medically necessary. Although it took awhile for everyone to get their act together, once it was in motion only my impatience seemed to be a problem. Source Dawn Yates Insurer Policy ASR (PPOM) Insurer Status Approved after first letter (9/1999) Surgery Type RNY Weeks to approval 12 Pre-Op BMI 70.9 Comorbidities arthritis, sleep apnea, spondololythesis Policy Must be medically necessary Source Jenn Barker Insurer Policy asr (ppo) Insurer Status Denied after legal action taken (09/29/04) Surgery Type Open RNY Source Linda Hinz Insurer Policy ASR (Phycians Care) Insurer Status Approved after 2nd appeal letter (12/17/04) Surgery Type Open RNY MD-supervised programs 1 (24 weeks) Comorbidities Diabetic, high blood pressure,arthritis,high cholestral Policy Must be medically necessary Comments All I can say is make sure you have your 6 months journals and make sure your PC puts your wieght and that its for weight managment on office notes. Also make sure Dr sends them to ASR every month. Source Debbie Miers Insurer Policy ASR (PPOM) Insurer Status First letter sent - still waiting (01/22/05) Policy Must be medically necessary Source Jennifer Brown Insurer Policy ASR Insurer Status Denied after first letter (03/01/06) Comorbidities Hypertension, Shortness of breath, Sleep apnea, back and knee pain Source Gabriela Medina asr, physicians care Insurer Policy asr, physicians care (pos) Insurer Status Denied after first letter (07/24/02) Comorbidities Arthritis in knee joints, inflamed ankle, incontinance, back pain Policy Must be medically necessary Comments Terrible, they change their phone systems all the time, so oyu can NEVER talk to the same person! They stalled incredibly, after papers were faxed in , it took them 15 days to even acknowledge that they were recieved. Then it took another month and a half to make the decision. They do respond to persistance. Source Kate Derks ASR/Physicians Care Insurer Policy ASR/Physicians Care Insurer Status Approved after first letter (03/22/03) Surgery Type RNY Weeks to approval 2 Comorbidities Sleep Apnea, Arthritis, High Blood pressure, Gerd Policy Must be medically necessary Comments They are good. Source Jen Dault

Thank you so much; I had seen those but there really wasn't much that was very current..I guess I am just anxious about the whole thing and I don't want to be denied. I have tried to have everything they would ask for...I guess now I just have to wait and see what else they want...the waiting will be the worst part - I hope!

Hi Stacey I want to welcome you to our big happy family of losers!! We are more than happy to help you with whatever we can. I don't have asr insurance, but i can tell you that most ppl don't get approved right away. In my case, it took a year because of all the appeals i had to go through. But even though it took that long, it gave me time to learn more and more about what i was about to do. Good luck to you Hugs Linda

Thank you Linda, I appreciate your helping me to look at what could be a long wait in a more positive way...I really needed that to help me turn my thoughts to an "everything happens in the right time" process! I am looking forward to learning everything I need to from those of you with the experiences to share! Thank God for OH and the people here!!!