new insurance

Our department is going to a new insurance as of 7/1.  We were Harvard Pilgrim but now we are going to a company that is an affiliate of them.  Can't remember what the name is.  But during the informational with them it was asked about the WLS.  The  reps said it was part of their insurance, so ok no big deal.  Now when I called to confirm I found out that I have to have doctor send in notes of medical necessity for WLS.  My PCP is all for it and I have already done everything else except meet the surgeon.  Does anyone know who writes the letter is it Dr. Gens or my PCP, or someone else?   thanks for the warm welcome to the group.  It's good to know I have people to help me along the journey.  thanks again.

Hello Jaimbry,     Pleased to meet you.  I have Dr. Gens, too.  I think you ought to call Nancy S on this.  I had to have a referral from my PCP to the WLS program.  But it is the program (PRH) that will submit to my insurance for approval.   My PCP has provided all sorts of things to Gens and is now done with the process.  It will be Gens that has to demonstrate medical necessity on my behalf.  Hope this helps.  Nice to have you and know that we do understnad the frustrations.  It is a long and complicated process and we all likely hit a few road blocks.  Treading

Thanks, Treading I'll call her on Monday morning.  I'm a newbie so everything has to clear through moderator, and b/c I work 3rd shift it is usually when I get to the site.

Welcome to the board. Hopefully your new insurance will be just as good or better for WLS. Goodluck!

Ann

so far so good, I'm all set with the new insurance, or so Dr Gens believes.  I'm just waiting to see what Tricare will require.

I've got my fingers crossed for you, Jaimbry.  You're really getting close to the finsih line.  Here's hoping Tricare comes through and you'll have little to no out-of-pocket expenses.  Treading