IS PACIFICARE OK???

I HAVE BEEN SLAMMED BY HEALTHCHOICE AND HAVE LESS THAN A WEEK TO CHANGE MY INSURANCE TO SOME OTHER PLAN (OPTION PERIOD). ARE THERE ANY "HIDDEN CATCHES" TO PACIFICARE THAT ANYONE KNOWS ABOUT??? I HEARD THEY WOULD COVER FOR MY SITUATION THE WLS....THANKS IN ADVANCE FOR YOUR INPUT!!!!!! KEN/EDMOND, OK

A friend of mine is scheduled for surgery on November 6th and she has Pacificare. She is a member on this forum also. I don't think she hit any snags getting approved but I don't know all the specifics so I will ask her to write you since you need to know quickly. She also works in the insurance industry and knows for a fact that Healthchoice has this surgery excluded. So in my opinion, you HAVE to change insurance companies if you want this surgery. Good luck.

Ken, I have PacifiCare and work for the state and had absolutely NO problem getting approved. After gathering all the records that I could (I have gaps in medical records because of lack of ins and the May 3rd tornado) Dr. Floyd's ofc submitted it and within 2 days, was approved. PacifiCare is pretty much like all of the other ins companies, they require having a BMI of 35 to 39 with co-morbidities, 40 to 49 with 6 months dr supervised diet and possibly a co-morbidity(?), and it is my understanding, a BMI of >50, almost a guarantee of approval. I'm scared to say that because I don't want to jinx anyone, but that was my case, over 50 and approved in 2 days. I think that Dr. Floyd is the only doctor left on PacifiCare, you cannot use Dr. Pearce. You've only got until Wed 10/29 to do this. Personally, I would go with the Hi or Low option because the Alternative option has a 20% co-pay for any inpatient admission and that could translate into $4,000 or more. I hope this helps.

Dr. Thomas @ Mercy takes PacifiCare too. He's my wife's surgeon and seems to have a good all-around bariatric program. And the answer to your question? No; PacifiCare is evil. They used to be worse though, not approving WLS at all. I understand they still don't allow the lap-band. My wife must be borderline on their BMI policy, so they're requiring her to wait and provide more evidence of less invasive weight loss methods before they'll approve it. HOW STUPID! If the less invasive measures WORKED, we wouldn't be begging for surgery! PacifiCare is evil. Now, let that be your mantra every night at bedtime.

Ken, I'm a little late on your post. But I have PacifiCare and I just had WLS and I was approved in less than 24 hours and they paid all but $280.00.I'm very pleased with them. Br. Bosquez is now a part of PacifiCare some how and I don't think he ever gets turned down. I know alot of people that come to Tulsa to let him do thier surgery. Talk to you later.Kelli