Have any non-UHC state employees been approved?

I'm just curious if there are any state employees out there with RAN-AMN, Schaller Anderson, or Arizona Foundation who have been approved in the last year or two for surgery?  It looks like UHC is approving a few folks (with a lot of difficulty) but what about the others?  My understanding is that Schaller Anderson does the review/approval for all 3 of these plans. If you have, or have not, been approved with these companies what were the barricades you had to hurdle?  (I have a copy of the criteria, so I know about the 6 mo. diet, co-morbidities requirements, etc...I'm just wondering what ADDITIONAL barriers they put in your way).

I haven't been approved yet but I am also on the RAN-AMN plan and I am in the middle of this crazy process.  I am in the second month of my 6 month dr. diet and will have an appointment with the surgeon's office in July probably to start that whole process.  So, I have a lot of the same questions you have in regards to whether non-UHC state employees have a harder time w/ approval but for know I'm proceeding as planned.

I have UHC, but I really think the coverage and the barriers with all the State insurance companies will be the same. Because the State is self-insured, the ins companies are really just 3rd party administrators. They do what the State tells them, to put it very simply.  I might be wrong, but the whole time I was fighting with UHC, they just pointed a finger at the State and said, "we're doing what your employer told us to do."   The barriers were "life threatening co-morbidities." Once I completed the 6 month medically supervised weight loss progam (with Dr Emershad at SBC), although I had high blood pressure, uncontrolled by medication, they wanted to see something more serious. My heart was good, so in the end, it was the sleep apnea that got me approved.  Post on the insurance boards too - you might get answers there. Good luck! Maxine JUST REALIZED WHO I WAS WRITING TO. Hi Connie!

Hi Maxine!!  Thanks for the e-mail and sorry I haven't answered yet...you got me going again, which is good.  I saw my PCP on Monday and he will be writing my letter that SBC requires, and am scheduled for the SBC seminar in June.  If they don't approve me, they won't approve anyone...I have heart disease, sleep apnea, risk of diabetes due to borderline blood sugar and strong family history, and the list goes on and on and on.

I have been trying for a year to get approved, I just got back my third level appeal, stating that unless I had congestive heart failure, uncontollable diabeties or out of control high blood pressure I could and would not be approved..   Max out there just sujjested a sleep study and That will be my next plan of attack/    Because the state is self insured they writhe thier own rules about approval, it is cumbersome and mentally draining.   Keep your head up and keep the attitude they will not win and its all in the end worth it.  With each and every denial thay came back with new and different reasons for denial, lol pretty soon they are going to stop finding reason and give it to me to shut me up :).   Help ful hint, they want to see councelling, nutritional, exercise and emotional.   and even thou you reash your 6 month Dr visit KEEP going.   They made a comming in mine that i Stopped after the 6 months, well duh it was a waste of my time and thier money, but if they want me to keep running up thier bills, i will start all over again, I got phone numbers if you need them, they lost my file no less than 3 times just to name a few..... Yes they are difficult, but you are worth it....keep on keeping on

Judi, Well, if we had those things we probably wouldn't be very good candidates for surgery now would we?  Does the appeal process ever take you to the insurance department or the Dept of Admin, or is it strictly within Schaller Anderson?  If they don't approve me, they won't approve anyone (see my response to Maxine above or read my profile).  I think I took the detailed description of my experience with insurance down when I switched from the old to new profile types, but you would not believe the hassle I had last year just getting a copy of the criteria...the first person I called said surgery wasn't covered, period, and I had to insist it was and I wanted a copy of the criteria....I literally was transferred about 10 times, each time the person telling me to read the plan description (no, that's not what I'm asking for), or saying  it wasn't covered, or they could not/would not give me a copy of the criteria.  (If I hadn't worked for the state for almost 30 years, in positions where I was a client advocate and knew to never give up, I'm sure I would have quit). Hang in there and keep us posted on your progress. Connie

i am going both, thru RAN/AMN AKA Fiserv.  LOL let me know what phone numbers you will want, been there.. The first few times I was on the line 30-40 min each time until I started writing down names.   You can also go thru DOA  for backup.   Department of Insurance will not take complaints they just refer you to DOA as we are self insured.   You are right once right before I hung up with them they let me know they dont cover this so bascially what am i even bothering.  I hung up an cried, then I got pissed and starting thinking  I dont think you can brush me off like that.   What is your email address I was on the phone, they will not release in writing any criteria ( poopheads) but i got this wonderful lady that read it to me, word for word , that phone call took some time , but God love her for that.  It is extensive and they will " interpert" it to thier own benefits at times... I will be happy to share what i have with you....I am not quitting this

I had no problem with RAN/AMN getting a written statement of the critera for the surgery.  When I called the number on the insurance called I ended up getting transferred to the case managment section of the automated system.  I skeptically left a message following a recording which said they would return my call within 48 hours.  Sure enough, later that evening I got a call from some case managment lady telling me about the exclusion except for medical necessity and the 6 month diet.  I stupidly didn't ask for it in writing, but called back a few days later, left another message, got a call back from the same lady and she promptly sent off a written statement of the criteria.  So far they have been very careful and she even reminded me to be very conscientous about the 6 month diet and not skipping a month or having a delayed appointment because she was dealing with denials on several people for the reason.  So far I have found the insurance helpful but expect that to become different once its time to submit for approval.

Let's hope they are beginning to become a little more cooperative...I had to finally start telling the people I was being transferred to that I expected them to send me a copy of the criteria, or send me in writing why they legally could not provide a copy.  Case Management was willing to read it/explain it to me, but refused to give me a copy.  I can't remember the section that finally sent it to me.  I hope it hasn't changed significantly since I got it last June, as I don't want to go through THAT again.  (I finally found my copy this afternoon). It is pretty clear that you have to have life-threatening co-morbidities, but it doesn't say they have to be uncontrolled; in fact it says "unstable medical condition" is a contraindication (as it should).

That's what I thought (that Dept of Insurance won't get involved as state is self-insured).  Thanks for your response, and good luck!!  I'm at more than 6 months away from appealing (I anticipate they will deny the first time just on principal) as I haven't met the 6 mo supervised diet criteria yet.