Badgercare Plus Security Health HMO

I was just wondering if anyone has had surgery with Badgercare plus Security Health HMO? If you did how "hard" was it to get approved.

I am currently doing their 6 months of required visits with the nutririonist and have my 4th (out of 6) on wednesday. We will then schedule my visits with the psychiatrist and the surgeon.

I am just worried that I am going to go through all of this and then get denied for surgery. I am just looking for others who have had "success" with getting approval.

My starting weight was 440lbs,BMI of about 75,  I have PCOS, have had gestational diabetes twice, was recently diagnosed type II diabetic, borderline hypertensive (at least at the Dr's).

What do you think my chances of getting approved are.

 Helen. Badgercare is one of the hardest insurances to get approved for but dont give up. my friends mom pretty much annoyed them to death. You know you need the surgery and all the struggles you are facing prove it so DONT GIVE UP!  You may need to get referrals but those are easy to get when it comes to wanting to better your health. Good luck!

Thank you Kaila! I have a referral from my primary care Dr and I am sure the surgeon will make a referral for it. I could also probably get one from my midwife who took care of me during both of my pregnancies and helped with the treatment and monitoring of my gestational diabetes. I also have an endocrinologist who took care of me when pregnant who I am sure would give me a referral as well.

Do you think if I had more then just my surgeon and PCP referrals that it might help more to get it approved?

 I think that just having those in general will do you well. I had no referrals but failed my psych evaluation which got me denied at first, thennnn i needed referrals.

Referrals never hurt. I think 2 will be enough and i think it can only improve your chances of getting approved. If by chance they stall and tell you some bogus stuff just call them out and do a one on one with an approval board member (if possible).

DONT GIVE UP THOUGH! Badgercare is a crappy insurance but you can beat the system alot of the time!

Hello!  Security Health is your HMO?  I have badgercare with Compcare HMO and I was approved within 3 days after my surgeon sent in the request.  Of course I had completed all the prio-rauth requirements, but I think you will be approved as well.  My BMI was 40 without and comorbities. My surgery is Monday October 25th.   Good luck to you.

Thank you Sartri. My psychologist I went to for my psych eval said that he has never heard of a problem with my insurance not approving it and was confident that I would have my surgery either in Dec or in Jan at the very latest.

I have one more month left of my 6 months of supervised diet and then they will submit it to insurance.

I see the surgeon next week so we will see what he has to say as well. But I am confident that it will work out.

I saw my Nut on wednesday and talked to her about my concerns with the insurance and she assured me that she has heard nothing but good about my particular insurance as far as my surgeons program goes. So that gave me some hope. She also let me know who in the surgeons office to talk to if I wanted to discuss it further. So I might give her a call on monday and discuss it with her.

Helen, I had badger care, but united healthcare through wisconsin, and I was approved in 3 day's! I know of a few people who have your insurance and have had no problem's, you will be fine. Not everyone get's there approval as quickly as I did, it does take up to 3 wks to hear anything, but I called and called and then I got the call on the third day that I was approved, I cried like a little baby..

Good Luck to you, which surgery are you going for?


TammyG.

Tammy thank you for your encouragement and sharing your experience with me. I am looking to have the DS I think. I have to meet with my surgeon on the 28th and will discuss it with him. But with the amount of weight I need to lose I think the DS is the best one for me.

I had my psych eval today and the psychologist told me he has never heard of a problem with approval with my insurance so I am praying he is right and that I will get approved. I have been doing everything the insurance company asks for and have been following the diet changes my dietitian has set up for me. I just hope Dr. Selwyn will be willing to do the DS. He has done them before and at his seminar he said that he will give you his opinion on what surgery he recommends but will ultimately listen to what the patient wants as long as they really are informed about it. So I am gathering as much info as I can. 

Hi Tami,

I also have united healtcare through badgercare of wisconsin.  Did you have to go through 6 months of dieting before you could have the surgery? 

Thanks