Keystone Health Plan East-PA

Anyone know anything about Keystone Helath Plan East-PA? I was wondering is it is hard to get an approval for RNY from them. Thanks...

I have KHPE - Generally speaking they are not overly difficult to get an approval from. There are no pre-surgery medically supervised diet requirements like many plans have.  Go on the Independence Blue Cross Website www.ibx.com.  Click on the tab "For Providers" in that section are online medical policy bulletins for different conditions - look under the one for bariatric surgery.  It clearly states the criteria they use in approving bariatric surgery.   After that, you can register at myibx and if you download the "welcome kit" - a complete copy of your particular plan should be included read it and make sure its not excluded. It probably is not.  Independece Blue Cross has these Blue Centers of Distinction for Bariatric Surgery which are preferred providers who meet certain experience and other criteria.  Generally speaking bariatric surgery is considered one of those services that require pre-approval.  Those 2 documents should tell you what you need to know.

Good luck.  P.M. me if you have further questions.

Rhonda S.

Thank you so much for that info, I was on the website but I couldn't find the information I was looking for and you directed me right to it!! So thank you, and your right, it is covered and I looked at my benefits and it doesn't exclude bariatric surgery so I am assuming it will be covered. I hope so, It took me a long time to decide on this and I am finally ready to do it.  I am meeting with the surgeon on Monday.....very excited!!!! 

Rhonda-

IBX just "put me on hold" until I do a medical weight loss program.  I dont see anywhere in the medical policy or my particular riders of this being criteria- I have looked everywhere.
Would you suggest I call or write them?

 I would call the customer service number and just ask has there been a very recent change in policy.  It hasn't been IBX-PA's policy prior to this.  Either 1) they just changed the policy or 2) its something to do with your particular medical situation.  Either way, I'd ask for an explaination in writing.

Peace,

Rhonda

Good luck! Where are you going for your consult?  I am scheduled for surgery on Tuesday at Temple with Dr. Meilahn.

Rhonda

Well, I am going to Barix Clinics in Langhorne and I am seeing Dr. Pupkova. I have heard many good things about her. Several people at my work have had WLS with Dr. Pupkova and they have had great results. Surgery on Tuesday? I am sure you are so excited....Good luck with that, I am sure you will do great! I look forward to hearing from you after the surgery to see how your doing! Kelly