PHYSICIANS ALLIANCE?

Ok here is it short and sweet.  My Insurance covers the wls with a BMI over 40 which i have. Seems i have to get my PA to approve me first, sighs*. How do i find out from them what the requirements are? I have Glendale PA in Cali Brenda

Brenda, Is PA the same thing as a PCP? Or is it a Physicians Assitant, or name of your insurance? Anyway, I would see if you have your benefits booklet that details all the coverage and benefits. Your HR should have a copy. If not, call your insurance comp and ask for the "requirements" or "criteria" for WLS. Sometimes they say that your doc has to submit or inquire for you. That's because they are hoping you won't meet their criteria when you submit, they deny you and you go away. Just tell them that you aren't going to start the process until you have a sense of whether you meet all the requirements (5 yr history of morbid obesity, medically monitored diet, etc). Tell them this is YOUR policy and you have a right to know the criteria/requirements! Tell them you want the WLS policy read to you verbatim, then ask them to send it to you in writing (or tell you where it's located in your benefits booklet or their website). Sometimes you have to get sent over to the precert/preauthorization department, and then you need to ask for someone (usually a nurse) who precerts for WLS. Get all full names of who you talk to, document dates/times. Good luck, Kahlua

The PA is different from the PCP. Seems even thought my insurance covers this surgery i have to be approved my the PA before it gets to them Thanks for your reply Brenda