PEBB Enrollment - New State Health Plans

I spent some time today trying to understand what the differences are in the Bariatric coverage for the new 2010 state-wide plan administered by Providence and the Kaiser option. Both appear to cover WLS, but I can't seem to find the details on what hospitals and surgeons are in the networks.

I understand that Kaiser usually steers their patients to Kaiser docs. Does anyone know who that would be in Oregon?

I see links to OHSU from the Prodidence site. Is this where they require the surgery?

Geez I hate open enrollment when the options don't seem easy to research.

 try people in your state.. Go to people foruum and go to your state. May get more responses.

I thought that was where I posted this... Is OH behaving oddly - LOL!

it is posted in the Oregon forum..very weird reponse up there :)..

I have PEBB too.  picked the providence plan that allowed me to keep my primary care physician.  I did not think to check the bariatric coverage so I am glad to hear that they all allow it!!

Tina

She's a friend from another board (BMI > 50) and probably saw my post in her MY OH and got confused. No worries.

How are you doing with that band, Dr. Tina?

Wow! Look at the new Dr. Tina! Nice Avatar!

Thanks!  I have gotten better about liking pictures of me. This one turned out pretty well. 

I did go with the new providence option.  I hope I am correct in thinking that I will get to keep my primary care doctor.  

 Patty - I'm an Oregon PEBB person.  Down here in Eugene, we can only get the Providence option.  They have told us that it is exactly the coverage we had with Regence BC/BS, so I would assume that for bariatrics, the surgeons have to be in a center of excellence.  That would mean you can go to OHSU, Legacy, St. Charles (Bend), Sacred Heart at Riverbend (Eugene), or Dr. Tersigni (I think is now a COE) over on the coast.  There may be a place in Corvallis too.  

Linda

Thanks Linda!

I did call Kaiser today, as I found the explanation they had of the coverage very fuzzy. I'm posting this in case someone else is as confused as I am about what will be best for me and my family.

According to some nameless female voice, they basically do what your PCP recommends. Generally that recommendation would be in network, which is in Clackamas. However the Kaiser site does say that for patients in Salen and Kelso, WA, referrals are for treatment at local hospitals.

Normally I'd not consider switching, but my PCP's clinic seemed understaffed, even before H1N1. I've got no idea what Kaiser is like, tho. DH had it years ago and recalled that it involved alot of waiting - LOL! Not sure how accurate that may still be.

I'm a Washington state employee, so I think my PEBB options are different.  I do know from other's that have Kaiser, they make you do a 6 month weight loss class that I believe the insurance does not cover.  They have quite a few hoops you have to go through.  Most insurances do, but they seem to be pretty time intensive.  For me, what concerns me is that they do not do laproscopic surgery....it is open.

Hope that helps.