MVP Healthcare

Just wondering if anyone has this insurance and how their experience was getting approved for WLS.  Thanks--

Hey getting educated andinformed preop is the way to go. In my experience though comparing insurance results has not been very beneficial or a good investment in time/energy. This is due to each person has individual issues that may factor into their approval (their medical comorbidities, their surgeons process and billing service, their individual insurance policy can differe greatly not all MVP insurance plans are the same for instance.....etc) although I realize we all want to lessen suprises and our resultant anxiety underlying this is one place I recommend finding out about ones own individual plan. That means calling the insurance company and asking for a copy of ones policy and reading all you can about the possible policy/parameters around bariatric surgery (is it a exclusion, what are the criteria) also ask questions when you call afterall YOU ARE THE CONSUMER!! Calling the surgeons office may also be of some minor beneifit asking how they see MVP inthe way of approval etc. Policies also change year to year!

Be well keep researching the life after is the focus I'd steer folks to! I know getting there sometimes seems like an insurmountable task! I had MVP had surgery just over 7 yrs ago and no issue....but that was then, my policy and me! HUGS!

Thanks Jamie!  I have already been approved for WLS through my current insurance EmblemHealth but just found out that my employer is switching to MVP on 1 Dec 09.  I've gone to MVP's website, downloaded their policies, determined if my surgeon is "in network", etc.  I'm scheduled for surgery on 24 Nov but want to have all my ducks in a row--just in case!

Shammy- Its good that you are having the surgery before you switch because I have been disappointed with MVP since Preferred Care merged with them in the spring.  They changed the requirements 3/4 of the way through and I had to pretty much start over.  I am now to a point that I get to met with the doctor and schedule a date and am very nervous that "something else" will be needed or changed.

Good luck!

CALL CALL CALL CALL and get a COPY of YOUR policy to back up what they say! I agree things can change midstream! Keeping you in my thoughts and prayers!

Hi Shammy!!

Have you learned anything about MVP? I know before I got GHI(Emblem) I called MVP and they told me that they were no longer dealing with the surgeon I was going to use.That is why I ended up with Emblem..but to no avail,I have an 11 month pre-existing condition clause! UGH! Then I came right out and asked them if I waited would they cover the DS? I gave them the code and they said no.That is why I am borrowing the money and pay for it myself..also am going out of state..it is so much cheaper in PA!
Can't wait to hear from you!

Kim

All of my docs are in Network for MVP so thats good and it looks like the product that I am getting with MVP does cover WLS--not sure about the DS though.  The requirements for approving surgery seem to be the same as my EmblemHealth EPO but again, I've seen MVP products that require the 10% loss.  Why the difference between products?  Makes no sense to me? 

I do not blame you at all for  1) going out of state and 2) going the self-pay route.  As I've said in the past, this process is not for the easily discouraged.  It takes a lot of determination, time and energy--and self-pay certainly does eliminate some of that stress!!

Sorry this is so long!  I'm a bit long-winded, I'm afraid!

Sorry I'm just now answering.  I only check in on this board once or twice a month.  I currently have MVP and my company is switching away from them in January, so we're sort of opposites.  LOL  They drove me absolutely crazy.  The customer service reps you call and speak to are, for the most part, absolutely worthless.  I looked at the info re: my plan and then also went online to check it out.  This SEEMS like it would be easy, right?  Well, I wanted to make sure as I know that websites don't get updated as often as they should, so I called and asked them to check the requirements.  The first girl simply said, "I'll drop the info in the mail to you." And hung up.  So I got the policy in the mail and it says they require a 5% weight loss prior to surgery.  Okay, not so bad.  I called again with another question and the guy I got sort of hemmed and hawed and then said, "Yeah, sure.  What you said."  Really helpful.  When I went to the first Nutritional Seminar (where they weigh you for the first time) the woman in the surgeon's office says that she sees I have MVP and did I realize that I needed to lose 10% of my weight prior to surgery.  I explained that I had it in writing that it was only a 5% loss requirement.  She said she thought it had recently changed. 

Back to the drawing board.  I called MVP again and spoke with a woman who I ended up spending 45 minutes on the phone with.  She looked through book after book and searched endlessly on the website (I didn't have my compter there or I could have guided her through it).  Finally I suggested that she call me back when she was able to find it.  I gave her all my phone numbers and times when I would be at each the next day.  Waited a week and never heard from her.  Called again.  A different woman from the first two.  She looked it up and read it off and gave me the 10% figure and said they had made many changes in June (yeah, like raising the premiums!) and that must have been one of them.  I asked her to mail the new policy to me for my files.   A week later I received the info in the mail and it was exactly what I had received the first time - said 5%!!!  I called three more times and was told 5% once more and 10% twice more.  Aarrgghh!  The story ended well as shortly after that my company announced that we were switching and I was thrilled as I really wanted the DS but MVP does NOT cover it and I was going to have get approved for the RNY and then appeal for the DS.  The new company covers it!!

I will say, however, that mostly the people on the phone lines are very friendly and polite and that's part of the problem.  They're SO nice that you absolutely believe everything they say and that can be a problem.

I will also say that I have had very little problem with them paying promptly for any doctor visit, medication, surgery, treatment or procedure I've had done over the past 4 or 5 years I've had them and I have otherwise been very satisfied with the service. 

Thanks vivimolly for your insight with MVP!  Getting the exact facts on what ins. companies want prior to submission of WLS request seems to be a nightmare all around.  I had a very similiar experience with EmblemHealth - GHI.  Every rep I spoke to told me something different.  Thankfully I had an awesome insurance person at my surgeon's office that got me approved in 4 days!

I hope the transition to MVP will be simple--luckily all of my current docs and surgeon are participating providers in my new plan.

I'm sure the transition will be simple and I feel reasonably sure that when everything's submitted to MVP, it will fly through.  Especially since you were already approved for the surgery with another company.  The DO have a funky requirements (that I had sort of forgotten about when I replied yesterday) that you might want to have a look at.  One is that you must have exhausted every possible method of weight loss prior to approval including a pharmaceutical option.  This was no problem for me as I simply called my doctor and she called MVP.  They accept a letter from your PCP that states that he/she will not prescribe weight loss drugs based on other existing conditions (primarily thyroid and blood pressure - those things are affected by pretty much every drug).  This might even have changed as she went straight to the top and spoke with the head of medical review and he was actually shocked that this was one of their requirements - must've been an old Preferred Care guy!  LOL  So you might want to look into that.  The other thing that they require is that you must have had at least 6 months supervised diet.  It doesn't have to be consecutive so you can count whatever you did at your last surgeon's office, weigh****chers, etc..  You may be asked to substantiate it, though, so you will need to be able to back up whatever you say. 

Hope I helped and good luck!