Question:
Approval for DPCI

Has anyone had Delaware Physicians care insurance.Im trying to find out what exactly the guidelines are for approval. I just called them it is covered if medically necessary but the reps don't have the specific details.    — moniquefrederick (posted on June 27, 2008)

June 27, 2008
Most insurance companies that cover the surgery require you have a BMI of 40 or higher or 35 - 40 with comorbidities such as high blood pressure, diabetes, sleep apnea. Insurance companies, however, vary widely from one to another, and sometimes even within their own organizations they go back and forth. You need to get to the person who can give you the answers you need....they are the only ones who can tell you what they require. It can be daunting to get the right answers (I know) and also to jump through the hoops both with insurance and the weight loss center. I thought it would never happen for me and then one day the sea parted and suddenly I was in. Good luck.
   — cjjordan

June 27, 2008
Monique, Being a nurse who used to work for an insurance company and determine medical necessity for WLS, I can tell you the customer service reps don't usually know exactly what is needed, however, call back and ask for a nurse or who it is that will actually determine medical necessity of your case. They should be able to tell you EXACTLY what you need to know. Also, ask for the name of the person, their direct extension and the fax number for future phone calls to decrease confusion. Ask for one of your Plan Brochures which should spell it out as well. Good luck to you, Dawn Vickers, RN, BLC, CLC
   — DawnVic