Group Health Cooperative

Has anyone here had any luck being approved with Group Health?

Hi Michelle I have GH and was approved after my 1st appeal. The key is to know their criteria and document every requirement when your request is sent in. If I remember right, these are the criteria: BMI 40-50 with documented co-morbidity ie..sleep apnea, uncontrolled HBP or diabetes or osteoarthritis. I think that BMI over 50 does not need co-morbids. They also require 6 months of supervised weight loss attempts in the last 2 or 3 years (don't remember which) I used my Weigh****chers membership. Then you have to pay for 1 year of nutrition counseling before approval is given (about $1400). My 1st request was just a letter from my PCP=DENIED. For my appeal I gathered letters from every DR I had seen, documented every requirement and wrote a personal 3 page letter explaining how my obesity effected my health. I submited this all in person to GH in a nice indexed binder, like a little presentation. About 3 weeks later I got my approval. I am on the East side of the state and had Dr Rawlins in Spokane. He is amazing. Wonderful bedside manner and a very skilled surgeon. Best of luck to you!! It is alot of work to get approval, but worth every minute to get this surgery...it is the best thing I have ever done. If you have more questions please feel free to e-mail me Kimberly 245/129/??

Hi do you have Group Health through an employer or a private plan? I am looking at purchasing a GH policy and hope that I can get WLS through them.

Hi Elizabeth My Group Health coverage is through my Husbands employer. I read your post about exclusions and some plans do have exclusions, our was for employees of a federal contractor. before you buy a plan, make sure that WLS is not excluded. In Spokane there are two Fantastic GH surgeons. Drs Bright and Rawlins of the Rockwood clinic. I can not say enough good things about this practice. Good Luck to you and e-mail me if you have more questions Kimberly 245/127/??