Question:
Anyone have Group Health that can share their experience on the approval process?

My PCP thinks I would be a great candidate and will submit my paperwork to the review board once I submit my documentation on WW and Curves. I am trying to get an idea of what to expect.    — Kathy J. (posted on May 18, 2004)

May 19, 2004
I have three words for dealing with Group Health....Document-Document-Document. I was denied on my PCP's 1st request because all she did was send a letter. For my appeal I compiled letters of medical necessity from my PCP, Ortho, Sleep Dr and Chiropractor(need co-morbids if BMI under 50). I included copies of my WW info (need 6 months within last 3 years) I also wrote a 3 page personal letter to accompany my appeal stating my family history and how my weight and co-morbids effect my daily life. I also stated that I had done a great deal of research, knew the risks and benefits of WLS and was prepared to make the lifestyle changes necessary to obtain a successful outcome. I also stated that I was prepared to pay the fee for their 1 year of post-op nutritional support. Make sure that everything is submitted in one packet, otherwise things may not get looked at together and GH wont see the whole picture. Once you sumbit everything, call once a week. Talk to the person working your case. In 3 weeks I had my approval and have not looked back. I am just over 5 months post op down from 245 to 155. I have had no complications and love my new life. I wish you all the best and please e-mail me if you have any questions~Good Luck, Kimberly
   — Kim2bthin

May 19, 2004
I second that info. Be warned: Group Health's 2 surgeons that perform WLS are Dr. Au and Dr. Bock. They are both wonderful BUT Dr. Au is on sabbatical and Dr. Bock just broke his hip and he may not be able to perform any type of surgery due to not being able to stand for long lengths of time. So, Group health has all WLS patients on hold for almost a year, and they do not have a back-up plan.
   — lizinPA