Any one has dealt with PHP Tenncare Insurance

If anyone has dealt with PHP Tenncare please let me know of things that must be done for them to approve it. I read something on the internet that someone had said you would need to get evaluation for Gastric Bypass for them to approve it. I can't remeember whos posting I reas that on. I would appreciate any help anyone is willing to offer. Thank you ahaead of time. Laura M.

Hi! I have tenncare select, but its all basically the same. I had a bmi over 40 with co-morbs. I didn't have any supervised weight loss attempts. Basically me just being fat with a few health problems was enough for tenncare to approve me. I was approved within 3 days. I hope it is as easy for you!!

There is a $3000 program fee they say Insurance won't pay for. Has anyone had to deal with their insurance on this? If so did they pay?

That $3000 extra program fee is just extra to go to the doctor, because they feel they aren't compensated enough. My surgeon doesn't charge any fees at all. There are several others who don't but they are booked for the rest of forever. Anyways, Dr. Hruska and Dr. Steely in Clarksville DO NOT charge anything and they are great. Dr. Hruska only does open rny, and Dr, Steely does open rny and lap band. I know its a long drive for you (me too) but its better than 3 grand out of my pocket that I can't afford. More good luck!!

I have been approved by TennCare Select and have my surgery on the 2nd of April. Here is what I learned. Surgery cost alot including lifetime after treatment. TC Select was willing to pay $950 for the surgery and I could pay $3000 for after care. DUH! I appealed stating if I could afford the $3000 I would not be on TC and therefore I was being discriminated againist because I am not rich. I won! You do have to follow certain rules. Go to ccfos.com and check it out, if it is good for you, call and talk to Ellen or ask for help on their message board. Everyone there is really nice and will answer what they can. Did you know that out of every 2000 denials only 450+ appeal? I am willing to bet they out of hand say no just to see who is serious. Suggestion: Have a good PCP and a wonderful case manager who you can talk to. They will be the folks to get you approved and halep you get all the things you need lined up and ready to go. Good Luck

Good Luck with your surgery!!! If you don't mind could you answer a few questions for me? Did you appeal through your doctors office? How long did it take to hear from the appeal? How long did it take to schedule your surgery afterwards?

Laura, I have a case manager as you should. If you do not, then you need to request one right away. That person is the one who helps you get this all together. I did my appeal through my case manager as she told me what I needed to get my foot in the door. I started with my PCP putting in an out of network request on Jan 30, 04...surgery was approved on 3/4 but they didn't want to pay the "aftercare fees" of $3000, appealed and was approved for the entire surgery and aftercare on 3/19. Truth is I couldn't have done it without a good case manager and a PCP who was willing to listen to me and do as I asked. I always took "papers" of information I had gotten online about the DS and why I wanted it more than anyother. I wish you luck and suggest that no matter what..........appeal appeal appeal until you are standing in front of a judge if you must. Debra