Anyone have Keystone Health Plan Central??

Just wondering what to expect from them...I will be taking a trip to St. Lucia next year so if I have to do the 6 month supervised visits, any surgery (if approved) would probably have to be pushed bac****il after I come back.  That would stink!

I have KS East. I have a POS and my surgeon is at Barix. Barix is their in-network provider and for me it took 24 hours to be approved with no 6 month supervised diet.

Is your surgeon one of their in-network providers? if so and you meet the requirements for surgery, i suspect you should be approved as easily as i was.

Good luck.

Hi Ashley, I won't be much help to you as I have KHPE and had my surgery just before a supervised diet was being required.  Can you check with your HR department or call the Blues directly?  If the plans run the same across the state I can tell you that I was approved within 24 hours of submission.   Sorry I can't be of more help.   Jeanne

Well the funny thing is that when I called Keystone, right away the person told me that bariatric surgery was not covered, on my employer site it says that it is covered if medically necessary, and then on the Keystone site the Weight Loss Clinic in Harrisburg is listed.  Weird...guess I will find out Monday!

I have KHPE and was not required to do a 6 month supervised diet.  My doctor, however, required several tests, which took some time.  I had sleep apnea and was required to log in 230 hours before they would do the surgery.  Bottom line, my initial consult was in May and my surgery was in October....a total wait of 5 months. I hope this helps.  Good luck!

I worked for KHPC a few yrs ago as a customer service rep. What they forget to mention to you is, that for most, no it's not covered. HOWEVER, if you jump threw the right hoops and yes it is medically necessary, then yes, after your doctor, then their doctor, then yet another specialist says ok, yeah, she better have this surgery, or she will die, then sure we will cover it. Remember, this was a few yrs ago (about 6) so things may be different now. Call them and ask to speak with the doctor or nurse they keep on staff. (they forget to tell you that too, there is a nurse on staff who will talk to you about your coverage) Good luck!

Boy they sure do keep things quiet!  Thanks for the info!

i just got denied twice by them to my surgeon's office, so now, i am filing a 2nd level appeal. if that fails, i have to appeal the dept of health, if that fails, i have to appeal the board of directors for the HR dept in the state dept i work for, if that fails, i do not know what to do. doctor says my revision of a vbg is structurally not my fault and i have a hernia too, and they said NO NO NO.  i am crying 99 % of my day/nights.

Well, after doing more research I found that it was actually my employer that doesn't have bariatric surgery listed under their contract with KHP.  Luckily (and you may have looked at my profile already) my Human Resource girl suggested looking into things during open enrollment season to find out if they made changes to the KHP contract or to see if the other 2 providers they offer will cover the surgery.  I only have to wait until November.  Don't waste your energy on crying, waste it on getting those appeals in!