Theresa23

Congratulations ecburger on deciding to have wls, it was the best decision of my life no regrets! Here is the link, if it doesn't work let me know I can scan and email the document to you. If you need any help understanding the insurance language let me know also willing to help. https://www.upmchealthplan.com/docs/providers/PandP/MP.040.pdf

Okay, well I will see you there then.

That's great hope everything goes well fingers crossed! Do you attend the monthly support groups? I have been to everyone but the one I missed the one in August.

Glad I could give you some hope! I have UPMC and I live in Allentown, Pennsylvania. Good luck hopefully your insurance approved you soon.

I live in Allentown, PA. I am having surgery with Dr. Holland at Sacred Heart Hospital. I was just approved by insurance, and will have surgery by the end of September. Where are you in the process?

My doctors group submitted to insurance a week ago, I asked them to submit before they thought I would get approved. I was told by the surgeons group, and several insurance reps that I needed to do a 6 month program, but I only did 3 and I was approved! Surgery is scheduled for 9/29. So excited!

Just in case anyone was wondering the outcome was I was APPROVED! My doctors office even thought I was going to be denied, and be forced to do another 3 months of weigh ins, but I was right about the policy and procedure manual.

I am going through the approval process with my surgeons office, and I have a question about my insurance. I have UPMC for you in Lehigh County, PA. I am getting conflicting information from call center reps about the requirements. Specifically the medically supervised diet, I have been told 3 months, 6 months and no diet is required. So, I found the Policy and Procedure manual on UPMC's website for my policy. It states that with a bmi over 40 (mine is 43) I need to meet one of the following requirements either have a co-morbidity, or have 6 months of doctor supervised weight loss. I have moderate to severe sleep apnea, which is a listed co-morbidity. So in my mind I meet the qualifications. However when I called back with the policy and procedure manual I was told that the 6 month weight loss program was a requirement of my surgeons group. This is not the case, I spoke to the nurse at my surgeons office and was told that they don't set those requirements. I just had my 3 month weigh-in and we decided to submit for instance yesterday. If I am denied will I be able to speak to UPMC's medical department that makes the decision? How long should I expect to wait for a decision? Any other advice or information would be appreciated! Thanks

I live in Allentown, PA and am having surgery at Sacred Heart Hospital with Dr. Holland on December 21, 2015. I would like to meet and talk with some locals as well.

My insurance company customer representatives are clueless when it comes to what the criteria is for wls. I have been told by multiple reps different requirements. Instead I requested a copy of the policy and procedure manual. I also requested a case manager be assigned by my insurance company, so I have one person dedicated to researching any questions I might have. Lastly you can express your concern/confusion with your surgeons office and request that they contact your insurance to clarify. Hope this helps. Good luck!