Tufts insurance and 12 month waiting period

I'm wondering how the folks with Tufts insurance are feeling about the new policy coming up next month about having to wait 12 months for WLS, and having to attend their behavioral weight loss program for that same period in order to qualify. Seems odd when Tufts NEMC has such a well known surgical program for WLS. The docs there must be real happy right about now. Are the patients with this insurance protesting? Does anyone know? Seems to me there must some sort of parity law this violates somehow. I hope employers will change companies.

There is more too this then just the 12 months. They also have stipulations on the criteria for what surgery type per bmi you would get. Lap Band for those under a certain bmi and RNY for anything above a certain bmi. When did an insurance company become doctors regarding someones health? I don't have Tufts but I'm concerned for those with health issues that do have Tufts. This needs to be fought and letters to the State Board of Insurance needs to be sent.

Wow, this is the first I've heard of this. I have Tufts Health Care and I was approved the day my doctor sent in the paperwork (in Dec.)... guess it's good that I got approved before this! I wonder if Tufts Health and Tufts NEMC are completely separate entities. I guess it doesn't matter since I'm having my surgery at Newton Wellesley! Kathleen

It MIGHT matter, Kathleen! I think a call to your surgeons' scheduling coordinator should explain it. He or she will know the insurance criteria better. I'm having mine at BMC and I heard about this weeks ago from Ellen at QMC (Dr. Hess). She said because my insurance is Cigna but underwritten by Tufts they needed to know ASAP which carrier I really had. One carrier is a 6 month program, the other will make me wait another year. Luckily, I don't have to wait the extra time, but due to the new criteria certain appointments had to be done before the beginning of March just in case. That's why today I have my appt. with Dr. Perna for my psych eval. Call your surgeon's scheduling coordinator to be sure, but I bet you're set otherwise they would have called you to rearrange appointments.

I have Tufts Liberty and was told in May that all my surgeon needed to do was call the 800 number for pre-authorization. I sure hope this doesn't apply to the libery plan. I've been in this stupid WLS program since May. I won't even meet the surgeon until next Thursday. This has been a tedious ride.

I was never notified my Tufts, but did find the notice of implementation. I hope this important link is ok to post. http://www.tuftshealthplan.com/providers/provider.php?sec=news&content=news_morbid-obesity

Thank you for posting this. I hadn't read it before. I really feel like I have dodged a bullet. The policy goes into effect March 6. My surgery is scheduled for March 5. It does say it will take effect with paperwork received after the 5th but still... I'm still feeling VERY relieved that I'm scheduled and approved!! Kathleen

Tufts notified the surgeons but not those with Tufts health plan of the changes. The 12 month program is via phone. Apparently if you lose weight over the 12 month period, it disqualifies you for surgery. Honestly, I wouldnt take ANYTHING for granted. Dont assume you are "all set" because I know they have certain dates that the surgery has to be approved by, and just because you are in a program, that doesnt mean you are "all set". Mass Health and Medicare have the 6 month program where you attend the physican supervised weight loss program. I dont think it is worse, but I dont know how the whole Tufts thing is going to fall out. It is not just NEMC. It is everyone with tufts health plan. I would call your surgeon ASAP to make sure you are in the right place, doing the right thing, and the timing is appropriate. I agree that it isnt fair. I think the 12 month program via phone run by the insurance company is basically just trying to weed people out. Seriously, how much can you learn in preparation for surgery talking to someone over the phone, who probably hasnt even had surgery! Those who have Tufts should consider writing letters in protest about this. STella