Regence-Selections/Regence Traditional Med Plans 4 WLS????

I'm looking for alterative insurance options in order to have WLS. Through my husband job at Boeing, these are my only  options to change my Group Health plan over to:
 
Regence-Selections CCP- WA  POS or to Regence Traditional Medical Plan - WA PPO.

I have until this Friday to figure if either of these Insurance options provide for WLS. Does anyone here know if they offer this option??? My current Group Health Plan which is 'Group Health Cooperative HMO - Puget Sound' does not.

The only reason I would change from the Group Health I have now is because I want the option for the WLS. Otherwise, my current Group Health plan that Ive had for 7 months now has been fine and the out of pocket costs minimal.

Any Ideas???? 

You need to contact the Benefits person for Boeing to find out which of these plans covers WLS.  GHC does cover WLS... if the employer has added that benefit to their contract. 

Good Luck...

Helen

Boeing Traditional covered my WLS. Selections doesn't. Traditional will cover a lap band or gastric bypass, but not the sleeve or the DS, if you meet their criteria, which seems to change from minute to minute! Ask Ragadolly! By criteria, I mean the usual co-morbidities, BMI, and Dr monitored weight loss attempts. In my case, they wanted 5 years (!!!) of chart notes from my PCP with my weight listed, and all my previous attempts at weight loss. Like Helen said, find out exactly what they will cover, and ask them exactly how they want it all documented. Get it in writing, and don't be afraid to appeal if they turn you down the first time. Be your own advocate. They make you jump through a lot of hoops, but it's worth it! I hope this helps. Good luck to you!

Thank you both for responding. I just got off the phone with Regence Traditional  (for Boeing employees) and asked them directly about their options for WLS and was told yes  - BUT BUT BUT....you are right, MAJOR HOOPS from the sound of it. A young fast speaking representative ( I had to ask her to slow down and pause twice) told me flippantly... "well they want to make sure you really just didn't go for WLS without positively trying to lose weight and you need good documentation etc etc....." I wanted to scream. Yes, I really want to have WLS and face that kind of risk to my life just because I'm a lazy overeater and think it's just so "easy" an option.   

She told me I would have had to have tried to lose weight within the last 2 years and be able to prove I went on some kind of program, well it's been about 4 years since I made my last *PAID* for attempt with Lindora Medical Clinic down in Calif. But I'm always "trying" in earnest to maintain my weight - except how can I? I'm a compulsive overeater who has yo-yo'd and now I have enough health issues to last me a short life time if I don't get the weight off. They also want you do Psychological testing. Great - just what I need to produce more anxiety. Don't they know that people who normally struggle with their weight have "FOOD issues and body image issues" so... will that be counted against me??

I felt frustrated and tried to keep from showing it over the phone. Also, you have to do a 6 month pre-op weightloss program but I don't know what my results "should be" another words what if I don't lose anything or I lose too much or or or.....I feel pretty angry right now. I feel exploited by this process and I haven't even started.
 
I am suspicious that me asking questions about the WLS through Regence Traditional will flag me in the system if we do change our insurance over to them. But my Group Health doesn't cover WLS and while I like them, otherwise, Regence Traditional may be my only hope.

Why is it with other addictions they have no problem paying for treatment? Why is it that it is a known fact that OBESITY causes major health risks and we are constantly reminded of them and yet insurance companies are allowed to disqualify you if you narrowly "miss" their criteria?

Pam, if I did change to Regence Traditional can you suggest any doctors who is WLS sympathetic and who is a general all around nice doctor??? I'm in the Renton-Seattle area.

I'm sorry for my semi-rant....feeling vulnerable and helpless and tired and silly and ashamed and angry that I constantly have to apologize for being a "weakwilled" person and PROVE that my health issues are serious enough and that my life is worth saving. That I'm worth helping. 

Thanks,
GO.


 

Hi Golden! As far as docs go, I was very pleased with my surgeon, Dr. Lauter in Bellevue. I wrote my thoughts about him in Pam L's thread yesterday. His office manager, Kelli was very helpful and knowlwegable about insurance requirements. I hesitate to recommend my PCP because he wasn't very knowledgable, helpful, or encouraging about WLS. He grudgingly completed the paperwork I requested after many reminders. All he could say about WLS was, "people have terrible gas and
diarrhea, and there are a lot of complications". Personally, I haven't had those problems, and he seems pleasantly surprised by my success! I'm thinking I'll switch PCPs eventually. Just don't feel like another Dr. search now. I feel so good now, my life no longer revolves around doctor visits!

Hi Golden,

Just saw your post - I had my surgery May 21st with Boeing Traditional - husband is salaried engineer.  I wnet through Hell getting here.  Hard for me to type - I'm still quite weak from surgery and caught a cold on  top of it.  I can probably give ou everything you need to know.  Think it's easier for me to talk on phone than type right now as my vision is still messed up!   I live in Maple Valley, and my phone number is  (425) 432-0156 if you're serious about this call me.  Also have some information on my blog's if that helps......

Donna/ragadolly

I work for Boeing and I have Regence Selections. They paid for my band in 2008 AND they paid for my revision to RNY that I just had last week.

My band had slipped in November, and I decided to go for revision. When I was approved for the band early last year, there was no requirement for a 6 month pre-op diet. When my surgeon, Dr. Lauter submitted the paperwork, we weren't sure if it would be approved or not, it could have gone either way, because we did not have a record of a 6 month pre-op diet. He was able to get the records from my band surgeon that showed 4 months of a pre-op diet, but not 6 months. Kelli, who works for Dr. Lauter, told me that Dr. Lauter wrote an "awesome" letter about my failed band and the chances for another slippage. Regence approved it on the first try, I did not have to appeal.

My suggestion? Switch to Regence Selections, and go see Dr. Lauter (in Bellevue). I love him! He is nice, and he does not require crazy pre-op starvation diets. Regence may require a 6 month diet, but Dr. Lauter won't make you starve before your surgery. If your insurance is not approved, his staff will help you with the appeal.

http://www.laparoscopynw.com/wst_page16.html

Good Luck to you!

 

Hi there Golden,

I actually work for the Regence Boeing Division in Member Services. I also have gone through the steps you are about to go through and had my surgery approved by the insurance.

If you would like, you can PM me directly and I can provide you more details about the Boeing benefits and maybe try to do a better job of explaining about the medical policy and criteria that Boeing and Regence has set forth for all potential surgical candidates.

I had to jump through the exact same "hoops" as their criteria is across the board now, but it really pays off to know what they need from you prior to requesting your authorization as it was very smooth for me once I knew what I was needing to do to get it approved.

Let me know and I would be very happy to help you!

John

Hi John,
I spoke with a Regence Boeing rep the other day and she directed me to the page on the website that explains the requirements.  It did mention the 6 months nutritional counseling, but i didn't read anywhere about 5 years of weight history.  Is this something they don't tell you until you've been denied, or have they changed their policy (eff 7/1/09)?  I was married two years ago and just found out I could get the surgery through my husband's insurance, so I too would appreciate any help or suggestions.

Thanks!

BK

Hi there,

The 5 year weight history was a Boeing specific stipulation that was removed on 7/1/08 to align with The Regence Group's guidelines.

Hope that helps.