WPS Insurance

I don't know if I'm posting this to the right forum, I'm really new here... but has anyone dealt with WPS Insurance for Milwaukee County emplyees?  I am just starting the process and I'm wondering what to expect. Laura

I have WPS as a state employee.  They did pay, but it was a fight.  Also, they've just changed their policy for 2008 (I just got the statement in the mail yesterday), so now you have to do 24 months of physician supervised diet before they'll approve!!  Unfortunately, that's probably the fault of state employees - we have a choice of plans, but have to pay significantly more each month for WPS (like 5 times more).  However, it's the only plan that will cover WLS.  So, tons of state employees have switched to WPS for one year, gotten the surgery, then switched back to a cheaper plan the next year, and I imagine that WPS has lost a TON of money on that. So, expect that they'll turn you down when you first apply, and give you a list of things to do before you reapply - the 2 years of MD-supervised diet, a 3-month trial of Orlistat (or a medical reason why you can't take it), and approval of the surgeon.  Once I met all their criteria, they approved me right away - in fact, I had my lap-band surgery within 1 month of finishing the supervised diet.

Thank you for the info.  24 months of a physician supervised diet is just nuts.  I've only been dieting most of my life.  Sheesh.  I was hoping that being diabetic might help my cause.  I guess I'll do whatever it takes.  Thanks for the info!  I see you've lost a lot of weight so far.  Good luck and best wishes on your journey.

The requirement is not that you have a supervised diet FOR 24 months, it is a supervised diet IN the last 24 months.  I had surgery with WPS - Standard Plan for state employees last year.  I had a six month supervised diet and was approved on the first try.  I specifically called about the 24 month statement because I felt like it was very vague.  They clarified for me, and obviously it worked! As for the rest of the process, once I was finished with my six month supervised diet, the clinic submitted the paperwork for me, and I was instantly approved.  I didn't even have a full trial of the weight loss medication because my doctor felt it was contraindicated for my medical conditions.  Luckily when the clinic submitted my paperwork for approval, I didn't even know they had done it, so I missed the agonizing wait time.  It really was effortless. I am so very thankful to WPS for allowing me this opportunity, and being the only state plan which recognizes the benefit of WLS.   I agree with the poster who made the comment about people switching just to have the benefit of WLS and then switching back.  I admit I thought about it, but then when I called a couple of the other HMOs that are less expensive, I found that if they did not cover WLS in the first place, they would not cover my follow up visits now.  I did not want to be without coverage so I opted to stick with WPS.  I'm very glad I Did. Hang in there ... hope you get approval soon!

Thank you so much Tess for posting that.  I was just reading over the info they sent me yesterday and I was thinking that maybe they just meant "within the last 24 months" and maybe not a diet for a full 24 months.  I'm happy for you that the process was so smooth and I'll be happy if it goes like that for me too. I can't say anything bad about any experience I've had with WPS thus far, they have been an excellent insurance company to deal with so I will anticipate that the whole process ahead of me will be relatively smooth.  The nurse that's coordinating everything mentioned that my doctor could write that the weight loss meds (i.e. orlistat) wouldn't be effective or there are reasons for me not to take it.  I'm going to try it if my doctor says OK, if I have any problems, I'll deal with those as they come. So I'm just getting started, wish me luck!  I have my first appointment February 4th. Thank you again for your post.

Laura - I had WPS and approval was pretty easy. I knew the requirements, and made sure everything was done before submitting. I did get an initial denial because my PCP hadn't sent in some specific info regarding my arthritis. Once that was in, I got approval in less than a week.  Best of luck to you!!

I also got the orlistat requirement waived, because I get migraines with all kinds of drugs. (OK, very strange - I'm also Kelly Jo W.!)

Hi, Laura, I work for the state and had Humana insurance.  I called them and they said they would cover my rouen y surgery.  Later, I discovered they wouldn't.  I switched to WPS in October, and they approved me before the insurance took effect in January!  I had the surgery 2 weeks ago, and am doing well.  I went to Froederdt w/ Dr. Wallace and have had a good experience so far.  He has a very good reputation.

I was wondering... I just found out that some of the things that are required of me aren't covered by WPS... including a nutrition class that I need and my entire doctor supervised weight loss proram that WPS requires before paying for the surgery.  They want you to do this but they won't pay for it. I'm very depressed.  I can't afford to pay my doctor $150+ a month for the weight loss program plus $100 for the nutrition class and this is just the beginning of my journey and there are quite a few other tests I will need and now I'm sure those will be paid for either.   I'm just really down right now.

I'm so sorry you are having so many problems.  I did, too--although Humana paid for all of my required expenses leading to the surgery, but they wouldn't pay for the surgery.  So, when I switched to WPS, I had all of the requirements completed. A girl in my office had WPS, and they paid for her requirements for lap-band, and then denied the surgery.  She appealed, they denied.  She went to some type of board, and was finally approved.  So, keep at it and I think you will succeed. It is depressing.  I had lost 30 pounds in preparation for the surgery, and then I was so depressed when I found out Humana would not cover, I gained it all back!! Now, I'm over 3 weeks past my surgery, and have lost 21 pounds, a pound a day.  I can't say it has been easy, but I am sure in the long run I will be much better off. Persevere, and better days are coming!! Sue