Coventry Cares WV Medicaid

AKD40
on 7/30/15 10:11 am

Has anyone been approved through Coventry Cares. Unlike straight Medicaid, you are only required to have 3 months of physician supervised weigh loss but I can't find any other guidelines that have to be met. I have the  sleep apnea, high cholesterol, GERD and Osteoarthritis so I know I meet the medical requirements but I don't know if they require that you lose a certain on your own. Anybody have any experience with them? 

KittysarusRex
on 9/11/15 5:31 am

If you find out anything please let me know!  I just switched and was working on the year that Medicaid required, so I may qualify too.

AKD40
on 9/11/15 9:24 pm

Coventry is easier to get approved than traditional Medicaid. They require 3 month supervised diet / exercise program and it has to be deemed medically necessary by your doctor. Good luck. 

KittysarusRex
on 10/7/15 9:01 am

I did some research and that all seems true, as far as they have told me, and I was told they cover all three and that it "just says gastric bypass." I've sent in all my info to the CAMC Weight Loss Center and it seems like it takes them forever to do anything. It's been a week and I can't get anyone to call me or contact me back to make an appointment to see Dr. Shin or to see if I need to have anything else sent to them. :\

KittysarusRex
on 9/11/15 5:55 am

I called the office I had planned on visiting and apparently they don't cover the sleeve or lap band, just traditional gastric bypass.  :\ 

Stormwatch72
on 11/20/15 6:24 pm

My Dr's office told me yesterday that coventry cares is now going to cover all 3 surgeries but when I started this journey back in August there was a 3 mth required visits and diet & nutrition counseling and then in Oct they told me it was changed to 6 mths and I went yesterday and,get told that aetna bought coventry and now it was gonna be 12 mths :( this is very discouraging for me and here I am starting my 4th mth.  I called Coventry my self and they acted like they had no idea what I was talking about concerning the 12 mth info so I called the Dr's office back and they were like "well we've heard 4 different stories from 4 different insurance reps and we're trying to get to the bottom of it and we'll call u back" does anyone else know what's going  on with this? 

KittysarusRex
on 12/11/15 12:58 pm

That's exactly what they told me and told me to call back last week to double check but I tried to call this week and my doctor's insurance lady has been on vacation.  And it's the exact same thing with me calling Coventry BUT the only thing that had changed is when I gave them the CPT code for the sleeve it was pre-auth.

 

Also, you aren't going to CAMC by chance are you?

Stormwatch72
on 2/13/16 8:17 am

Sorry I haven't logged on for a while but yes I see Dr Rossi with CAMC. Who do you see? They've since changed things again to 6 months and I have my 6th appt Feb 24th at which point they say they'll request authorization from Coventry. My fingers are crossed hopeful that they don't change thus again when I go on the 24th :(

Stormwatch72
on 2/13/16 8:23 am

Plus no one has said a word to me about regain or even having to lose weight pre op.... I have anyway on my own ...very little but they also understand I'm on steroids for rheumatoid arthritis which makes it very hard to lose.

I go the 24th and I'll keep you posted with what they say then. Would lI've to chat more wirh you. My Facebook is stephanie saul hoover if you want to add me ... I also belong to the Facebook gastric bypass group with Is very informative.

KittysarusRex
on 12/14/15 5:37 am

My Dr's office said for sure it's now 12 months supervised, NO REGAIN.  Not even a pound.  If you regain a pound, you have to start over.  Dietitian and everything still.  I've already disqualified myself so I'll have to start over now.

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