Community Care Hmo, Anyone else????
Hi,
I am getting ready to try to get approved for WLS Here in Tulsa. Does anyone else have Community Care Hmo? Any thing i should know about dealing with them? My current BMI is 40 my only Documented Co-morbidity is Depression. Although i will make a visit to Dr. next week to discuss urinary incompitence and back pain. Anyone have a great Pcp to reccomend that will actually refer me for this surgery despite the loss of money on their part? I have read else where my current Pcp will not( omni medical) Does anyone know if they require a 6 month Physician assisted weight loss? I did this about 3 years ago through a local weigth dr. but was wondering if it had to be sooner than that? Any help you guys can give will be appreciated. I am sooo glad i found this website.
Aimee
I am in the somewhat in the same situation that you are in. I have BCBS of Ok which will not cover WLS 
, so I am going to change to either Community Care or Pacificare at the first of the year. I looked at our company policy with Community Care and at least in 2004 they will cover it, but did say had to meet their standards - or something like that 
whatever that means. I did read somewhere else on the boards that they do require 6 months supervised weight loss effort.
As far as Omni Medical goes - my doctor is a part of that group. I talked to him in July about this - and he is supportive. Has a couple of surgeons that he will recommend. Now I have not talked to him since I found out that I am going to have to change insurance, but at least he was for it. I actually mentioned trying the St John's weight loss program (Optifast) - and he said that while they were good at getting the weight off, it would come back and that he thought surgery was the answer for me. He has been my doctor for a number of years, so he knows my struggles.
Good luck. 
Sharon
, so I am going to change to either Community Care or Pacificare at the first of the year. I looked at our company policy with Community Care and at least in 2004 they will cover it, but did say had to meet their standards - or something like that whatever that means. I did read somewhere else on the boards that they do require 6 months supervised weight loss effort.
As far as Omni Medical goes - my doctor is a part of that group. I talked to him in July about this - and he is supportive. Has a couple of surgeons that he will recommend. Now I have not talked to him since I found out that I am going to have to change insurance, but at least he was for it. I actually mentioned trying the St John's weight loss program (Optifast) - and he said that while they were good at getting the weight off, it would come back and that he thought surgery was the answer for me. He has been my doctor for a number of years, so he knows my struggles.
Good luck. Sharon 
Debleyduu
on 9/29/04 12:55 am
on 9/29/04 12:55 am
Aimee,
I also have CommunityCare HMO. I just found out this information from them. As of January 1, 2004 (or at each companies next annual renewal) they will no longer cover WLS for most policies. If you work for a company that has more than 500 employees, your company will have the choice to purchase a rider that will cover WLS. If they don't buy the rider - CommunityCare will not pay for it. If you work for a company that has less than 500 employees, the rider will not even be offered.
My understanding is that if you have already been approved, they will go ahead and pay. If you can get still get approved with a surgery date before 01/01/05, you may have a chance.
After that - I think we're out of luck. I know I've pretty much given up. I plan to switch to my husband's insurance in January, if I find that they still cover WLS.
Sorry to be the bearer of bad news....
Deby
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