GHI/HMO....now I'm confused
ok, so a month ago I called my insurance company to find out what their clinical criteria is for Gastric BYpass...2 ladies told me that I needed to be on a physician supervised diet....I called my surgeon..and he said when I came back for an appt we would discuss this...I had the appt Thursday..and he decided to put the paperwork into my insurance co and see what happens...well..friday I received a pamphlet from GHI/HMO with the guidelines..and it has really confused me..the way I'm reading it..I only need 6 months supervised diet.."recent9within the last 12 months) history and documentation submitted a evidence of active participation and reasonable compliance with at least 1 physician-directed weight loss program for a minimum of 6 months. I'm not sure why they told me 12 months...does anyone here have any experience with GHI/HMO...and what they asked of you?? thank you in advance
i HAVE GHI but I have PPO AND it was an interesting ride you need to go by what they tell you and what they want from you only everything is diff by dr and insurance company
I got denied first time I appealed myself and won my surgery is next monday
best of luck in your journey i know you need 6 consecutive months monitored by PCP with the PPO I have in addition to dr's requirements
(deactivated member)
on 11/12/06 9:32 pm - MT
on 11/12/06 9:32 pm - MT
Lori,
I hate when you get the run around when you call to find out about the requirements! I don't know why they do that but I had GHI PPO when I had my surgery and they required the 6 month weight loss program with the PCP. Other then that you will have to trust in your surgeon to see that all things are met, I would call the Ins myself to see if there is any info in the system yet. My Dr's office said do not call but I called every day and it took 4 days to approve once they had it in the system.
Keep us posted hun! I wish you all the best! ~hugs~
Debra P 
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