Question:
Has anyone had PacifiCare HMO in California?

They say that they now cover Bariatric surgeries at 100% as of 11/1/99 , but I want to make sure that I get an approval. Anyone have any ideas?    — Becki S. (posted on December 14, 1999)

December 13, 1999
I have PacifiCare HMO in California and was approved for Open RNY back in October. My surgery was 10/29/99. The key to approval with them is to start with your PCP and have him refer you to a surgeon w/in your group to do the surgery. I didn't have a single hassle with them, nor did I have to contact them one time during the entire process. They did, however, require a psych. eval, nutritional consultation, surgeon's approval & PCP approval, plus a diet history. I hope this helps. Good luck and if you want more details feel free to email me privately.
   — Brealynn

December 13, 1999
I have PacifiCare HMO of California and was approved in six days. I was never asked for further information and everything went well. I do however, believe it still has a lot to do with your surgeon and what medical group your pcp is in. My pcp is under Monarch which is a medical group in south orange county. My surgeon, Dr. Le Port, contracts for bariiatrics with Monarch so I really believe that made it go a lot quicker. I have also found that a lot of the surgeons I looked into, didn't take PacifiCare. You should first make sure that you check out the surgeons in your area, find out if they take PacifiCare and then talk with your PCP. What area are you located in? Shannon
   — Shannon O.

December 14, 1999
I have PacifiCare and was approved quickly through my medical group.
   — Morgan B.

December 16, 1999
I have Pacificare HMO Kentucky. I was approved after a month on a first time basis. No appeal or anything. They covered everything so far but the copays.
   — snicklefritz

December 21, 1999
I have Pacificare HMO in Texas and have been denied twice already because they say I haven't tried hard enough to lose weight without it, although I have no idea where they got their information. I just think they're hoping you die first.
   — Barbara C.

February 2, 2000
I just recieved the latest coverage information for Pacificare HMO and it states that "surgical treatment for morbid obesity will be covered only when criteria are met as recommended by National Institute of Health (NIH)." I go to my PCP tomorrow to ask for the referral.
   — Laurie W.