Badgercare/Group Health co op

Hi I am hoping there are people that have experience with my insurance. I went through the 6 month diatician (so very long) , Had the psych eval and saw him for a few extra visits for my depression. (Passed this time) Have all my Dr. referals... I have diabetis, herniated disk, high cholesteral,IBS, family history of heart disease 100+ lbs. overweight ...jumped through all the hoops....I hope. Now I just have to wait for the psychologists papers to get to my surgeon. Then he will write his letter for the insurance...& I get to wait on pins and needles...... I'd like to know if anyone here has my insurance & my surgeon Tim Pitchford , Eau Claire. also how long a wait you had to hear if you were approved.. Thank you, Stephanie

Steph, Hi My name is Pat. I do have your same insurer. However I had my surgery in Steven's Point WI. with Dr. Reising. I was denied the first time my insurance letters went through. I had a 6 month apeal process after which I was finally approved. I had RNY lap on Sept. 9 2004. I hope you will have smooth sailing when all of your paper work is submitted by your surgeon. BadgerCare is typically pretty picky about this type of surgery from my experiance. Calling them for preauthorization is more of a hassel than it is worth. Let your doctor do most of the foot work. Become educated do all of the research you can and study the insurace portion of this website and seek out others with your insurer. I had to appeal their denial. It sounds like your doing every thing right so far. Do a google search for Bariatric Surgery and BadgerCare. This will tell you the prequalifications for surgery and also you can find some of the appeal info if you need to file an appeal. I was told by the insurer that if your BMI is over 39 you will be approved or if your BMI is 35 to 39 you can be approve if you have one or more comorbidities. They will ask for 10 years of doccumented medical records that show that you were over weight and seeking treatment with diet records and all former weight loss failures. Have all of your medical records to prove comorbidities and back-pain and weight problems write a letter to your insurer explaining that you know the risks of this type of surgery and are willing to under go any and all Doctor's orders to achieve a healthier life style. In the letter also explain that you have tried and list the weight loss failures and explain that you and your team of bariatric surgeons feel this is your last and best chance to maintain a healthier life and prolong your life. If you want to see copies of my personal and appeal letters you can email me at [email protected] I am glad to share them with you. Like I said before hopefully every thing will go smooth for you and you will be approved soon after your paper work is turned in. Good luck and keep us posted on your progress. This page is your best place to vent so post often there is always someone willing to help and listen. Pj Manning