GHI Insurance?

Does/did anyone have GHI insurance for WLS? If so, how strict are they?

Hey Mikey, I have GHI Flex Select, (can go in or out of network without referral) and they are not that bad but do stick to wanting their requirements met. You need to make sure you have a 6 month supervised diet, diet history, psych evaluation, sleep study,ekg, and have to go to a nutritionist. you also have to write them a letter of why you think you need it done, and you need to have your pcp send them a letter also. You can check out my profile, it goes into more detail.... I was denied the first time but was approved a few days later after an appeal. Hope I helped! Good luck! If I can help you in any way, let me know, also, make sure you keep copies of everything, they tend to lose paperwork and it's quicker to send a copy yourself than it is to have the dr resend.... Gia 261/218/125

I am so frustrated! I don't know how I should get the 6 months thing. I have info from only March 30!! I dont know what to do. Other than that, I have co morbids... Who the hell goes to a PCP when they start dieting? I am so scared that if I get denied, I'll die.

Ask your pcp if he could write you a 6 month supervised letter.

I already asked. He said no because HE has no record of me coming in. I guess he's worried that the insurance will check his records?

Mikey, Dont get frustrated. First off, your surgeon should know what the ins co needs as far as what tests you have to take. If all you need is a 6 month supervised diet, start going to your pcp now and and make sure that you go every month for 6 months.... make sure he charts your weight every time you go and after 6 months have him write a letter to the ins co stating that you have completed the supervised diet. Dont give up, you need to fight for what you want! Some ins co's require 12 months.... 6 months is not that bad.... If you have any questions, feel free to email me.... Gia

Mikey, Please don't get frustrated, like Gia said, go to your PCP now and start your weigh in's, if you have to wait for 6 months it might be better then submitting your paperwork and getting denied. I just wish I had the exact answer for you but I don't, your surgeons office should be helping you with this!!! Good luck Debra P

Hi Mike, I too have GHI (CBP), however, my surgeon hasn't submitted the paperwork (even though I'm hoping for an August 1 surgery). Hopefully he'll have everything he needs by the end of this week when my pcp will submit his letter, my baseline history (whatever that is), my physical and the supervised diet records. I wish I could tell you more.... All I know is GHI requires pretty much what's standard with most insurance companies: pulmonologist clearance (which may include sleep study report), cardiologist clearance, nutritionist and psych evaluations, and pcp clearance including chart notes. When I called GHI they did not mention anything about a letter from the pcp or one from me, but insisted on the 6-months supervised diet records. However, from what I've read here and going by others' experiences, I think it would be helpful to have both of these letters too. I am starting to lose hope that my surgery will happen within the next 19 days though....sigh... My recommendation to you, like Debra and others mentioned, since you do need the 6-months supervised diet, go ahead and get it started with your pcp... Another thing, if you haven't had a sleep study yet, tried to get that done soon...In my case, I had to go for a second one and from the time I went to the first one to the time my pulmonologist reported the final notes on the second one, it has been almost two months...which is what has delayed the process for me. I just got my cpap machine delivered to my home on Sat. 7/9 (my first sleep study was 5/13). Hope this helps...Good luck to you! If I can be of further help, feel free to email me. Dolly

I have GHI CBP. I received an approval in less than a week. They require that you have documented 6 month supervised diet, Psych Eval, Nutritionist Eval and PCP letter. I also gave my WLS a personal history of all diets I've tried for the past several years. However, your WLS surgeon should know what your insurance require.