Care Source

I am hoping that someone can help me out with some answers.... Does anyone know what you need to do tobe approved for wls by Care Source? Also, has Care Source EVER approved anyone for wls before? I have heard that they never approve anyone.. Right now all I know id that they expect a 9 month doctor supervised diet. Thanks!

Unfortunately, I have not had Care Source as an insurance provider before.  However, you can check with your plan's coverage documents (e.g. explanation of benefits or summary plan description) to get the details on what will be covered and the what the specifications will be.  You can also contact Care Source's member services department to get telephonic information surrounding the guidelines for coverage. I hope I was able to provide with the information you required.

Thank you for your reply . I have actually called them and talked to them 2 times.  First time I was told that after all the paperwork was submitted and all requirements met it would take 7 days to be approved. Second time all I got out of that csr was, "it depends...we dont want to approve anyone for such a dangerous operation unless we have exhausted all other means"  I kept asking what all I needed to get approved but he just kept saying, "it depends:"  I got nothing out of him at all and I told him he was not helping me. Thanks again...

The response the second representative gave you was inappropriate. There are specific requirements for the surgery, and there are available someplace.  Have you checked the company's Web site?  You might want to call back and ask to speak with a supervisor or someone in the escalations department.  When representatives are quoting benefits to you, they are doing so from plan documents that they have at their disposal! The bottom line is that you have a valid question, and it needs to be answered.  If the representatives are unwilling to be specific with you, then escalate.

Hate to be the bearer of bad news, but Caresource has extremely strict criteria. It's also not up for discussion. You MUST meet all aspects of the criteria, which is as follows: Nine consecutive months of documented physician supervised diet (provided in the form of office notes that includes diet, exercise, behavioral modication, etc).  Severe, uncontrolled, IMMEDIATE life-threatening co-morbid conditions. Examples include: brittle diabetes despite high dose insulin treatments, medically refractory hypertension despite multi-drug therapy. So in other words, you gotta be on your deathbed with diet documentation in hand. It doesn't matter if you weigh 700# and have every co-morbid thinkable, especially if they're controlled by medication. They suck.

Wow...yeah, they do suck :lol: My diabetes is not the greatest..right now averaging 230 on a fasting check...I do not have hpb but do have high cholesterol but it is doing ok with meds... I have back problems and arthritis that affects my knees and hips pretty bad...I also am having trouble with my left leg between hip and knee..the skin feels tingly like it is going to sleep and it burns..when I bend over and stand back up I feel something "pop" and accross the top of my leg it feels like someone snapped me with a rubber band... I have severe problems with yeast infection (on my skin) which is due to my weight..no cream I have been prescribed will work... Will any of these problems help me out with getting the surgery? Do you know how Molina is about the criteria for wls?  I can change to them in May.. Thanks for the information...it is very helpful :-)

No, Molina isn't nearly as strict. They require more pre-op testing for clearance, but no phys supervised diet and they don't appear to be as strict as far as co-morbid conditions. You'll have a much better chance of being approved through them. If your diabetes isn't brittle or life-threatening and you don't have the diet documentation, it doesn't matter if you have the other things you mentioned, Caresource will surely deny you.