Pacificare of CA - Healthy Roads

I posted this on the California message board, but I hope it helps those of you who are struggling to be approved for surgery:

I just received a call from my attorney *****presented me in my appeal against PacifiCare of California and their Healthy Roads requirement.  H.R. is the 6-month coaching program that patients are required to complete before being approved for surgery.  It was not a WLS education class. 

I fought PacifiCare and won my case in early May of this year.The timing of my case was important for two reasons. I was the first patient to appeal the HR program and I made my appeal just months before PacifiCare needed to renew their Certificate of Coverage with the state of California.  My case brought attention to PacifiCare’s sneaky maneuver to delay/stall the approval of potential WLS patients

The aftermath of my case has opened the door for PacifiCare patients to be approved for surgery!

The certificate of coverage was recently renewed on October 1st.  The Healthy Roads requirement has been REMOVED from their plan! Several patients have been approved since submitting their requests after October 1st.

I asked my attorney about the patients who are currently enrolled in HR. This was her recommendation:

If you are currently enrolled in Healthy Roads: Continue your coaching calls, DO NOT quit the program. 

Ask your doctor to submit a NEW REQUEST for a surgical consult or surgery, even if you had been previously denied.

If you are denied based on the Healthy Roads requirement, contact Obesity Law (www.obesitylaw.com) for further assistance.

This whole experience has been a significant victory, not just because I got approved for my surgery but because now it has opened the door for so many others coming after me.

Even a single person can take on a large organization like a managed healthcare provider and win.  I will always have a great respect and admiration for Walter & Kelly at Obesity Law for all of their help. Dragon-slayers of the world unite!!!