group health insurance

Has anyone been accepted by group health for RNY recently?  If so any pointers to help me out with the process?

Hi there!!  I have Group Health, have had it all my life in WA (36 years).  They are pretty good about approving the first time.  I was approved the first time for lapband and was banded 4 months ago.

Have you talked with your PCP yet? 

Any questions, feel free to ask! :) 
 

 

 

i am in the process right now dealing with PCP.  I have to get sleep study done to check for sleep apnea.  I didnt realize they would allow lap band...

The process will take a few months, depending on when you have appts., etc.

First talk with PCP, he/she will make referral
Get accepted into the program
Telephone appointment with case manager
Series of tests
such as 24 hour pee collection, mammogram (if you are a woman), blood work, chest x-ray, sleep study, stomach x-ray (with barium  eww)

Then you have to sign up for accomplish weight management which will be a year of nutrition counseling which is really very helpful especially after the surgery. They want you to lose at least 5-10 percent of excess weight (I had to lose 12 lbs, I ended up losing 15), they will give you a surgery date, schedule you for the 4 hour class and a pre op appt with surgeon.  The surgery will be at Overlake Hospital next to Bellevue Medical Center Group Health.  It is an awesome hospital. 

Start by going to support group monthly. 

 

 

What type of Group Health do you have?  We have PEBB.  What Dr. did you have for surgery?  Co morbidities?  Is the year of counseling after surgery or before?

I never had PEBB, just through employers, but now i am an employee of Group Health.   I had Dr. Landers.  He rocks. 

Yep, i had co morbities,  sleep apnea, high chloestrol, diabetes, arthritis, but most of them has improved and i am reducing meds.

The NUT counseing starts about 8 weeks before your surgery date and lasts a year after your surgery.

 

I have not had a good experience at all. I weigh 340, have high BP, diabetic, sleep apnea, PCOS, metabolic syndrome, arthritis+. They still found a way to deny me. My doc explained I have tried several diets, still NO!! My GH does have the benefit. So, I dont get it. My Doc said they always say NO?? Tips would be great. Do you know how I can help myself?

Dreamweaver

Have you appealed??   It probably also depends on your employer too. 

What type of GH do you have?  Appeal the decision.  I beleive you can appeal 3 times.

I have group health and it depends on your plan.  I was totally shot down.  They said I had no co-morbidities so even if I was approved I would be put on a long wait list...wasn't worth it to me.  I pay a lot for my premiums, so I was pretty disappointed.  Oh well...Good luck to you