TennCare Questions
By some odd blessing in disguise, I lost my job and went from private insurance (United Healthcare) to TennCare. To my delight, I found out that TennCare covers WLS!
I called TennCare since I hadn't rec'd my card yet and found out that they assigned me to BlueCare. I searched through OH and saw several folks listing that BlueCare gave them few problems and the majority of folks were approved.
I live in Cleveland, so I called Memorial WLS Center in Chattanooga. Only one dr., Dr. Sass, takes BlueCare. The gal that I spoke with said that typically BlueCare wants you to either do 6 months of Weigh****chers *or* 6 months of a physician supervised diet. So I signed up for the seminar for today, even though Dr. Sass doesn't require attendance. I wanted to meet him and get a feel for him.
Well, I was very satisfied with him. He had RNY 2-1/2 years ago so he personally knows what you will be going through. But... afterwards in speaking with his insurance/front office rep, I was let down quite a bit.
According to her, she said BlueCare is the hardest of any oif the TennCare groups to work with. She said aside from the 6 month supervised diet (she didn't mention WW at all), you have to prove that you are *disabled*... basically that you are incapacitated by your weight. Some examples she gave were being on disability because of your weight, using a cane or wheelchair, etc. She advised me to call BlueCare to get a complete list of what is considered acceptable as far as proof of being disabled.
Here are my questions:
In all of the posts I have read through on here, I didn't come across any BlueCare/TN folks that mentioned having to meet this criteria. Did any of you have to jump through this loop or could this gal be mistaken? (BlueCare was closed by the time I got out of the seminar, so I have to wait until tomorrow to call them.)
Another dr. I am considering, Dr. Boyce out of Knoxville, takes TennCare, but only the AmeriChoice plan. I am wondering if AmeriChoice member have to jump through this same loop or if their requirements are more lax than BlueCare's. If anyone on here has AmeriChoice, could you please let me know what your requirements were?
I'm sure I could be classified as disabled due to all of my health problems. Pretty much any activity hurts my body, even sitting for short periods of time in an office chair. But I really don't want to go that route. If I tried to get on diasability, I'm sure it would take a very long time. I've heard people saying it took them years to be approved.
Any input on either of these insurances would be extremely helpful and appreciated. I have 45 days to switch to a different network within TennCare, but I want to be well prepared beforehand. I can't exactly call TennCare and tell them, "Hey, I need WLS, which netowrk will be the easiest for me to get approved?", LOL. If only it were that easy!
Thanks in advance for your help & I hope everyone is enjoying their evening!
I called TennCare since I hadn't rec'd my card yet and found out that they assigned me to BlueCare. I searched through OH and saw several folks listing that BlueCare gave them few problems and the majority of folks were approved.
I live in Cleveland, so I called Memorial WLS Center in Chattanooga. Only one dr., Dr. Sass, takes BlueCare. The gal that I spoke with said that typically BlueCare wants you to either do 6 months of Weigh****chers *or* 6 months of a physician supervised diet. So I signed up for the seminar for today, even though Dr. Sass doesn't require attendance. I wanted to meet him and get a feel for him.
Well, I was very satisfied with him. He had RNY 2-1/2 years ago so he personally knows what you will be going through. But... afterwards in speaking with his insurance/front office rep, I was let down quite a bit.
According to her, she said BlueCare is the hardest of any oif the TennCare groups to work with. She said aside from the 6 month supervised diet (she didn't mention WW at all), you have to prove that you are *disabled*... basically that you are incapacitated by your weight. Some examples she gave were being on disability because of your weight, using a cane or wheelchair, etc. She advised me to call BlueCare to get a complete list of what is considered acceptable as far as proof of being disabled.
Here are my questions:
In all of the posts I have read through on here, I didn't come across any BlueCare/TN folks that mentioned having to meet this criteria. Did any of you have to jump through this loop or could this gal be mistaken? (BlueCare was closed by the time I got out of the seminar, so I have to wait until tomorrow to call them.)
Another dr. I am considering, Dr. Boyce out of Knoxville, takes TennCare, but only the AmeriChoice plan. I am wondering if AmeriChoice member have to jump through this same loop or if their requirements are more lax than BlueCare's. If anyone on here has AmeriChoice, could you please let me know what your requirements were?
I'm sure I could be classified as disabled due to all of my health problems. Pretty much any activity hurts my body, even sitting for short periods of time in an office chair. But I really don't want to go that route. If I tried to get on diasability, I'm sure it would take a very long time. I've heard people saying it took them years to be approved.
Any input on either of these insurances would be extremely helpful and appreciated. I have 45 days to switch to a different network within TennCare, but I want to be well prepared beforehand. I can't exactly call TennCare and tell them, "Hey, I need WLS, which netowrk will be the easiest for me to get approved?", LOL. If only it were that easy!
Thanks in advance for your help & I hope everyone is enjoying their evening!
If you can find a surgeon that accepts TennCare without a second insurance...you had better HURRY UP and get your surgery!!!!!!! I have Medicare and Medicaid .... I searched everywhere and MOST places I called didn't want to accept TennCare unless I had a second insurance and some wouldn't accept TennCare at all!!!! Saint Francis Hospital in Memphis is a Center of Excellence and Medicare requires that WLS be done in specific hospitals and with ONLY approved surgeons. The Medicare website will have approved hospital and surgeons listed on their website. I wish you ALL the best!!!!!
Leticia
Leticia
Work like you don't need the money......
Leticia
Dr. Boyce also takes PHP Tenncare but I had no luck getting changed from BlueCare to PHP. It is full and they arent taking new enrollees. Tenncare is pretty much the same across the boards when it comes to weight loss surgery. I think the requirements are the same. I'm working on the 6 month supervised diet right now. I'm using Dr. Hodge in Johnson City. I have my first consult with him on Monday. I know nothing about having to prove I'm disabled though I am to get the surgery. That has never come up. Things have changed during the last few years with Tenncare. Each surgeon will also have his own requirements for surgery, like a certain percentage of weight loss before surgery. It depends on who you choose. Dr Hodge's partner also takes BLuecare and also I think Dr. McDowell at Baptist Hospital Metabolic Surgery Center in Nashville. I saw him and he is good but you have to get your approval for surgery before you can see him as a patient. I wanted a surgeon who would help me get through the approval process. I hope you find some one.
GOod luck.
Karen
Leticia - thanks for the well wishes! I also encountered most doctors not taking TennCare, too, once I started calling around.
Karen - The dr. I am probably going to have surgery with also wants you to wait until you have already completed the 6 month diet before you even see him. I'm not really happy about that. My PCP said he was going to still refer me now because he feels we should get everything else out of the way while I am on the diet, so I can get the surgery as soon as possible. So we'll see if my PCP can pull some strings and get me in there sooner.
As for the disability part, it's listed on the TennCare forms section - you can view it here: http://tennessee.gov/tenncare/forms/bariatric.pdf.
I called BlueCare yesterday to find out about the requirements and was told that those are set directly by TennCare, not the individual networks. When I looked over the form, I saw the disability section and realize that is what's required. Unless for some weird reason they have not updated that form and changes have occurred. I would definitely check with your doctor though. And... if you find out that Dr. Hodge's office says that isn't a requirement, would you please let me know? I'm closer to Chattanooga, but if Dr. Sass won't see me until the 6 month diet is behind me and Dr. Hodge will see me (and as a bonus says the disability portion is not required or he knows how to "get around it"), I have no problem going to see him. I want this done as soon as is humanly possible!
Thanks for the responses, guys.
Karen - The dr. I am probably going to have surgery with also wants you to wait until you have already completed the 6 month diet before you even see him. I'm not really happy about that. My PCP said he was going to still refer me now because he feels we should get everything else out of the way while I am on the diet, so I can get the surgery as soon as possible. So we'll see if my PCP can pull some strings and get me in there sooner.
As for the disability part, it's listed on the TennCare forms section - you can view it here: http://tennessee.gov/tenncare/forms/bariatric.pdf.
I called BlueCare yesterday to find out about the requirements and was told that those are set directly by TennCare, not the individual networks. When I looked over the form, I saw the disability section and realize that is what's required. Unless for some weird reason they have not updated that form and changes have occurred. I would definitely check with your doctor though. And... if you find out that Dr. Hodge's office says that isn't a requirement, would you please let me know? I'm closer to Chattanooga, but if Dr. Sass won't see me until the 6 month diet is behind me and Dr. Hodge will see me (and as a bonus says the disability portion is not required or he knows how to "get around it"), I have no problem going to see him. I want this done as soon as is humanly possible!
Thanks for the responses, guys.
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