Who to believe

Does anyone out there have recent experience with Ohio Caresourse? I have been told so many different things about them that I dont know who to believe anymore. I was told (by a WLS Rep.) that they have never approved WLS. I was told that they are one of the better ones for approving WLS. I was told to get ready to fight it out with them but they would eventually approve it. I was told they would pay if it was deamed "Medically Necessary" but you practically have to be dead before they will. I was told that they paid for it in the past but now have a "written exclusion policy" and would not pay for it at all. And the list goes on. I have even tried calling Caresource. But can't even get a straight answer from them. "Plausible Deniability" So who is a person to believe. The problem is I want to believe it will all work out. but then I hear that it will not. I feel like I am on a roller coaster. Truthfully sometime I just wish the ride would stop so I can get off. One day it is good news and I am happy. The next day it is bad news and I am all upset about it. Well enough from me. So does anyone have the answer to this question? Jimmy

I heard they do cover it if it is a medical necessary. I heard yoiu do have to fight with them and not give up as well. I dont think you should have a problem with your bmi Best wishes Barb

If you have Caresourse, do you have a company policy? At this point have your dr submit the claim and see what they say. The worst they can say is NO and then you have some idea if they have an exclusion or not. You are the only one that can find out that answer cause every policy is different from employer to employer or policy to policy even through the same insurance. If you don't start the process it will only take longer so take the plunge and see where the ride takes you. I ave been at this since June 04. You have good days and bad days, you fall down then you have to get right back up and go back at them and NEVER let them know that you may be sick of fighting. Just keep at them. Sounds tough don't it .... this all coming from someone that was so mad last night at a denial letter from the legal department at BCBS of SC. Well they have not seen the last of me cause I pay premiums and they have been jacking around with me for some time and every time that they say just makes me even madder and do not want to let them win!!! No one should have to fight like this to want to save their own life but insurance companies do not care about our quality of life they just think about the bottom line...MONEY! Good luck to you and sorry about rambling! Shelia

My insurance company (UHC) is hot/cold. If your employer purchased a rider to include WLS in their policy, its a piece of cake. If they didn't get the rider, then not even dancing naked chanting will get you approved. My best advice to you is to call the number on the back of your card and just ask them what kind of requirements they need to get approval for surgery. UHC was happy to share with me. Good Luck Valerie

Well I think the dancing naked part is out. I would probably get arrested for public endangerment.

Jimmy, Hi. I am the Insurance Coordinator for Dr. Trace Curry's office. I have worked with Caresource as recently as December. So, unless things have changed since then-here's the scoop. Caresource WILL cover the bypass if there is medical necessity. You must also complete a physician supervised diet for 9 months (although it was previously 1 year). The diet must be documented in physician notes on a monthly basis. A letter will not be sufficient. I am not 100% sure about a psych evaluation. I will need to check on that one, as I am home and not at work to review my notes. If you would like, on Monday I can email you about the psych. I can also mail you a copy of a list of the requirements, given to me by Caresource, that will hopefully clear up any confusion. Please email me your home address and I will be happy to supply that info. Good luck!! Tracy Burch Insurance Coordinator Dr. Trace Curry's office 513-559-2544 [email protected]

LOL Jimmy! MY RULE: NEVER DANCE NAKED.....UNLESS NOBODY'S WATCHING!!!