Question:
I have Pacificare, the only official diagnosis I have ever had was high cholesterol..

I have Pacificare insurance of AZ and the only official diagnosis I have ever had (co-morbidity wise) is high cholesterol. I have been on a million diets, but none that were doctor-supervised. I have a strong family history of heart disease (early in life) and breast cancer, I have other complaints of reflux, swollen and sore ankles, shortness of breath, but nothing documented except the cholesterol. Will this hold up the process??    — Kimberly P. (posted on July 21, 2001)

July 21, 2001
Kimberly, Yes this will hold up the process. I also have pacificare and have to do a six month program of seeing a dietitain and therapist and had to go to physical therapy this has been going on for 10 months now and still no luck I am going in for a member satisfaction hearing this month. Good luck!
   — Angie H.

July 21, 2001
I have PacifiCare too (California). I was denied at first because of lack of life-threatening co-morbidities. Then I wrote an appeal letter and got approved. (I'm now 4 days post op!). What I found out was, in my case, it was NOT PacifiCare but my MEDICAL GROUP that was doing the denying...it took PacifiCare to get me approved. I called and spoke with one of the agents at length about "exactly" how the process worked. Once I understood that, I was prepared to deal with the Medical Group when I told them that I KNEW I met PacifiCare's guidelines (100 lb for 5 years) and in addition had family history, etc. ,etc. When it all came together, they approved me within MINUTES of getting my final paperwork. Good luck to you!
   — blee01

July 21, 2001
Hi, I have PacifiCare HMO Colorado. I'm not sure about the entire PacifiCare network, nationally, but I was approved on my first try, no comorbs, never on a supervised diet. Now I do have a BMI over 50, and was told by many other PacifiCare members that is your BMI is over 40, and you've been obese for more than five years then more than likely you will be approved. But who knows what makes these insurance companies decide who gets and who doesn't. Best of luck to you!
   — [Anonymous]

July 21, 2001
Hi! I have PacificCare HMO/ California and was denied 2 times and working on my 3d denial. PacificCare in the end was my saving grace. They immediately contacted my med group and wanted to know what the problem was and informed them that they were going to help represent me in my EXPEDITED APPEAL. When I got my 2nd denial, I found out then that it was my medical group NOT PacificCare. I called and made an appt with my primary care dr and RAISED THE ROOF AT HER OFFICE. I told her that if I didn't have an approval in 15 days that I would do nothing short of exposing the medical group to the news media, newspapers, internet, picketers at their med group and that was only the beginning. I WAS NOT GOING TO GO AWAY! Needless to say that when I left her office that day, I had a msg waiting for me at home to call her ofc and I was APPROVED! Amazing that sometimes you REALLY have to stand up for yourself and push yourself COMPLETELY over the edge to get what you deserve. OH YEA.....I did meet EVERY criteria set forth by PacifiCare guidelines.....they just thought that if they kept denying me that I would give up and go away. BOY DID THEY PICK THE WRONG PERSON TO DENY. They had no idea...My PCP did ask me though AFTER my approval, if I had passed my psych eval....we had a good laugh over that one....incidentally...I DID PASS THE PSYCH EVAL WITH FLYING COLORS....Don't give up hun....This is your life and don't let them make decisions for you...YOU HAVE RIGHTS AND MAKE SURE THAT YOU GET THEM.....
   — Joi G.