WV PEIA Insurance - Need Info

My niece has the WV PEIA insurance and has been refused 3 times. Any suggestions or information she could use to help get the surgery approved. I don't know all the details...but any info I could pass on to her would be greatly appreciated. Janet

Janet, sorry your neice has been turned down so many times. Have her write a letter to PEIA. Include any sibling illnesses, grandparents, relatives, any diabetes, strokes, heart attacks. Anything life threatening. Good luck and God bless. Marlene

Dear Janet, I was denied on my first try with Accordia and I thought I had all of my "ducks in a row". The problem I ran into was not enough record keeping from my PCP. Have her call Accordia's WLS rep, Vita. She had me fax my info to her and she looked at everything and told me what else I needed. A quick summary: 12 months of documented weight loss history. Details are very important. She has to have co morbiditys like Heart disease, GERD, Hi Blood Pressure, Diabetes, ect.. as well as several more. Her BMI must fall within their range. Vita can tell her if she qualifys. A psych evaluation that she must pass!! If the Psych Doctor doesnt feel shes ready, they will turn it down. Less than 3 abdominal surgerys. Thats all I can remember off the top of my head. Make sure she goes to the seminar where the Doctors staff can look at her records and advise her before the submit to the insurance company. Good Luck to her! Jen