Group Health

Hi, I'm just starting the approval process with Group Health, has any one been through this. Any help would be appreciated. Thanks, Jerry

Hi Jerry. I have Group Health and am scheduled for surgery on December 21st. If you have any questrions, I would be more than happy to answer them for you. I know that their coverage will be changing in 2005 and you will not be required to enroll/participate in a six-month commercial weight loss program. However, from what I understand, you will be required to achieve some weight loss before the surgery. Also, some plans will be dropping the coverage completely. But if you just started the process, I would think they would have told you if that were the case for you. Good Luck!

Hi, Thank you for your repy. I just got done reading your profile, hope everything goes well for you. I have just finished 6 months with the Weigh****chers Online program. I'm glad to hear they accept the online version, next week I'm starting the meetings with my wife, she has been going for the last 6 months and has lost 40 lbs. I'm very proud of her sticking with it. I talked with the plan administrator, she told me I was covered at least until next July when our contract ends, I'm hoping to have it done by then. I see you are having a laproscopic RNY surgery, do you know if thats the standard for GH or what your doctor prefers? Thanks again for answering, Jerry

Hi Jerry, I too have Group Health. I am still in the process of getting approved. Was denied the first time because of lack of information. So now I am waiting on my doc to get me a letter of med necessity. I believe that RNY is the standard for GH. Lap or Open. Good luck with your approval. Lori

Hi Lori, I was just denied because of lack of info too, the doctor did not include the info from weigh****chers because he thought they would contact me for it.... rat's, I would really like to get this rolling. Let me know how your appeal turns out and good luck. Did you happen to use weigh****chers? Jerry

No I didn't do weigh****chers or anything else for that matter. I was told by Harriet at Dr. Bocks office that the requirement of 6 months supervised dieting in the last 3 years was going away in January of 2005. So... I am going to submit my appeal next month. I am just waiting for my doc to right me a letter of necessity and a letter from my gastro doc who diagnosed me with severe acid reflux and a hiatal hernia. Hopefully that will be enough "info" for them to reverse the denial. Nothing like that was sent in the first time. It was just a one page form that my doc signed with my weight and BMI and the fact that I have sleep apnea and arthritis in my hips. I am crossing my fingers that what I send in for the appeal is enough. Diet history, medical history, letters, etc. Good luck with you and I will keep you posted if I find out anything else that might help you! I think once you send in that you have been doing Weigh****chers that you will be approved. Lori

Lori, Sorry for the delay in thanking you for you help, I've been out of town for work the last 3 weeks. I decided to wait until Jan to submit the appeal so I won't be wasting one in case they didn't like Weigh****chers online. I have not heard a word about the rejection from my PCP, he's the one that suggested sugery in the first place... oh well. Have Happy Holidays and I'll write when I get some news. Thanks again, Jerry