PEIA insurance

I am trying to find out information about west virginia peia insurance. I would like any information about what they require, how they are to deal with and what percentage they pay on the surgery. thanks for any information.

Vickie, The current criteria that we have been dealing with is BMI > 40 alone or >35 with co-morbidities. The other thing they require is that you have 12 months of physician supervised dieting in the past two years. This usually has to be a comprehensive program with a dietitian and an exercise component. The good news is that they are currently doing a pilot program for medical weight loss that they are paying for. Dr. Stickler

I too am looking at having the wls and i have peia where would i find information about this pilot program you are talking about?

Deborah, I'm not sure who you are supposed to talk to but if you call our office, the receptionist can give you a number to call. 304-347-4313

Vickie, I have PEIA and had WLS in 7/04. There criteria changed right after I received approval. You have to document your weight loss attempts , the most recent being the last 6 months to 1 year. I wrote a letter outlining all diet attempts and failures, and including all the problems I was having due to my obesity. It also helps to have a contact at PEIA/accordia. I worked with a lady there and she let me know exactly what was needed. They will pay for 80%. I have ended up with medical bills of about $1,000. They were helpful, but I would definitely suggest dealing with the same person all the time. email me if I can be of further help. Good Luck. By the way, I started out at 281 (7/04) and am now 194. I went from a size 22-24 pants to a 14!!

Vicky, If you go to the PEIA website, there is a link to the document of their bariatric surgery requirements (which changed in May 2004). The biggest change is in the amount of medically-supervised weight loss documentation - you must now have 12 months of medically-supervised (not Weigh****chers, LA Weight Loss, etc) within the past 24 months. Make sure your physician documents at each visit what type of diet you are following, amount of exercise, behavioral changes you're attempting to make, etc. While you are getting in your required time of medically-supervised weight loss, periodically contact PEIA or go back to the website to make sure nothing has changed. When I started working toward WLS we only needed 6 months and since I wasn't ready to submit for approval by the time of the change in requirements, had to extend to the full 12 months because there was no way to "grandfather" me in under the old requirements. My insurance approval is under review at this time, so wish me luck! I wish you the best in getting the information you need and in deciding upon this journey. Mary Ellen

Thank Goodness!!! I finally found other people looking for the same info I am. I just started my "12 month diet plan" with my family Dr. I am an impulsive, however compulsive, person. I want this surgery yesterday. Looks like I will have to be patient. URRG!!!!!

hey glad to have been of some help. the information i was looking for was for my sister. she has since gotten a packet from peia to try the 12 month diet plan and something about a pilot project they are doing. if you would like i can have her email you the information about that.

I have PEIA as well and I started out in the MWL pilot program. I voluntarily dropped due to my own inabilities to stick with it and because of some outside problems. Now I wish I'd have stayed in it no matter what, eventho I think its too late to try to stay or be put back in it since I'll have to be on some sort of plan for at least 6 months. I'm just now starting out in the WLS portion, learning and filling out forms, writing letters, etc. This is tedious but I feel it is very worthwhile. We'll see, one day at a time, how this will pan out. Wish me luck. Any insight on Acordia PEIA would also be very much appreciated...thanks!!!