Phoenix Health plan, AHCCCS

Hello all,

I have ahcccs (Phoenix Health Plan) and I was wondering if anybody has been approved through them, what type of surgery, and how long it took...any info is greatly appreciated!!! I am hoping to have the VSG. When I call them directly, nobody can tell me what the requirements are. My surgeon says that they use the Mercy Care requirements because they couldn't get an answer from PHP either. I asked them if the VSG was approved and the guy said no, that it required a prior authorization but I am pretty sure they all do. Just wondering if anybody else has had experience with this. Thanks so much!

Consider switching your plan to Mercy Care, they approve more often then Health plan.

They all, meaning AHCCCS have to follow the same guidelines for approval.

They claim they are: 5 years medial history of obesity, 6 month supervised weight loss losing 5% of body weight, and then all the pre op evaluations and tests.

They really are: 2 years medical history of obesity, 6 month supervised weight loss program where you do not gain any weight, and the pre op evaluations and tests.

I went to Dr Simon first, and was denied, for I gained 2 lbs in my weight loss regimen. If I had known what I now know, I would of considered wearing heavier clothing on the first weigh in then the last. If they had known, and informed me, I would of starved myself a week to lose those 2 lbs, but at that point I already thought I had failed. I did not know the truth was all I needed to do is stop gaining. 

I switched to Banner Gateway bariatric Center, in East mesa. They are so knowledgeable with dealing with insurance companies hoop jumping and excuse making, that they have a 95% approval rate from them. They require more then they do, but in a good way. All surgeons tell you not to smoke, it interferes in healing, but they actually nicotine test you. All tell you support groups and education are benefits, but they require attendance in a minimum of 2 information sessions. These are examples. 

They also have much better success rate then average with keeping the weight off, because they use a comprehensive weight loss program, where the surgery is just a tool. I highly recommend them. I will be submitting a request fcor coverage again really soon, and am 98% sure they can not deny me this time.