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HELP!!!! Does anyone have medi-cal/medi-care..or molina insurance??

August 25, 2010 by shayna_bayna

:wub::eek::thumbup: So I switched over from Kaiser Permanente insurance because I heard that Molina insurance covers bariatric surgery...I feel as though I'm getting the run around but I'm not too sure. How do you go about the whole process. I talked to Molina and they said I have to do 24 classes of Weight Watches.. which is fine but they span over a period of 6 months..and I still have yet to receive the voucher for weight watchers from Molina..Is there any loop wholes that I'm not seeing?? Can I go straight to the surgeon and get in there faster?? And is there any other insurances on Medi-Cal/Medi-Care that cover bariatric surgery??? ie. Aetna... Community Health Group...

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I know if you have medicare they would be consider your primary insurance and to my understanding just as long as you have a medical condition. You are approved...

with medicare there are three easy steps.

1. Medical condition
2. Do you have medical history to show you have been obesed for a few years
3. Have you tried in the past to loose weight. Such as Jenny Craig, Weight Watchers....etc.
Hi Shayna

There are different steps you can take as far as getting your procedure covered. I have experience in the insurance industry so I’ll give you a little bit of my knowledge. You may already know some of this information. You may send me a message if you feel your questions and answers are too personal.

1. Are you on an individual or group sponsored health plan?
2. If your group health plan is the group is the health plan self-insured or fully-insured. (If you work for a large corporation most likely your plan is self-insured and the best place to start is your HR Department). If you are on a group plan and the plan excludes the surgery ask the HR Manager/Director if they are able to amend the health plan next enrollment to include that procedure.
3. If you are on an individual or small employer plan call the prior authorization department and ask if the following CPT codes are covered under your health insurance contract; 43770, 43644, 43645. There are more CPT codes, but those are some of the normal codes used for the Lap-Band procedure.
4. If the insurance company said they will NOT cover Lap-Band that means your insurance excludes that procedure and they will not approve.
5. If the insurance company will consider you for approval, I’m encouraging you to follow their requirements to the “T” or you will be fighting for months with appeals. This process takes several months because a lot of plans require you to try other weight loss options.
6. Go to a bariatric seminar in your area and choose a surgeon. Their staff is the most knowledgeable and they are familiar with the insurance carriers’ rules for your region and they will be able to guide you through the process. I encourage you to pick a surgeon with a team that is actively involved because it makes this process a lot easier. Also, see if your insurance carrier has a preferred surgeon for the procedure because his/her office will be able to receive approval faster than others.
This is just some suggestions but use your best judgment. I wish you well during your journey.

Aetna cover bariatric surgery. I was approved in 1 day.
aetna with medi-cal?? did you have to do 6 months monitoring you weight.

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