Molina Healthcare/ Washington Apple Health

[Fhionafaye 2]

I was able to get through the 1st stage. I've spoken to the clinic in Portland. OWL. They told me they are just now processing the paperwork and we will get the ball rolling soon on making appointments for the second stage. I completed the online seminar and filled out the application PDF. My Dietician MD sent out the referral and she, the weight loss clinic, and Molina have all said that the first stage is complete.

I was given CPT codes by the clinic for bypass and the sleeve. Molina confirmed that they will cover both if I meet the requirements.

I was told that I may be able to do a sleep study at home and mail it back in. So that is definitely one less worry.

Here is a current list of requirements for pre-surgery/surgery.

I haven't been able to find may people that have information about going through this insurance recently. All I could find was two dead posts asking if anyone knew anything about Molina in Washington. Both did not have a reply.

My worries are that I'll have to drive to Portland 12 times minimum for only some of the visits over the next 6 months. Along with all of the other requirements like seeing a sleep specialist, psychological evaluation, etc.

This is only a problem because I live an hour and a half away. I'm worried that may not let me see someone locally for some or all of these things. Does it really have to be 6 months, can it be less? I know you can get an extension. I'm also sure it would be hard to cram in several visits in a short time. I still wonder if there is any sort of legal loophole any other clinics may use? Anything like less time or fewer visits.

I live in a rural area and between my husband's health, work, time and financial constraints, I'm starting to wonder If I need to wait. Healthwise my HBP is getting worse and isn't responding well to diet or medication. We have small children and he has extreme exhaustion from having SCA 5 years ago. I'm not sure I'll be able to make it to visits that are 1 1/2 hours away. Is there truly no way to fast track something like this if the Insurance has such detailed and extensive protocols?

Would none of the information I have from dietitians over the last few years count? Does it all have to be new information?

Health Information: 315lb, 5'5, HBP, PCOS, Social Anxiety, Joint Pain, Lower Back Pain without Sciatica, Postpartum Hernia. I'm not sure if all of these details were only needed for the first stage of authorization. Has anyone been able to speed up the process? (Probably Wishful thinking.)

Thank you to anyone that took the time to read this and anyone that may have answers or advice for me.

-Fhionafaye

[catwoman7 10,881]

that would be up to your surgeon and your insurance company. I would call them and ask.

[Uomograsso 364]

If you have to do 6 months of physician supervised weight management, you might be able to do that with your primary care physician. I had 90 day program my insurance required and was able to do it with my PCP. You might be able to do things via video chat as well. A lot of insurance companies are pushing that now. Don't be afraid to call doctor and insurance company to ask a lot of questions.

[KayLow42 28]

My husband had weight loss surgery in Portland with OWL. We lived two hours south at the time. He had to drive up many times to do it. They also do not give adequate pre-surgery counseling or follow-up. I would not recommend them because of this. The surgeon is great and the process moves quickly, but compared to my program, they did not provide adequate pre surgery education which has led to his surgery and efforts being less successful than mine.

[Danidab64 2]

The schedule is controlled by the insurance company. I live in a rural area and my doctor/hospital is 2 hours away in another state. They allowed me to attend support groups that were local and scheduled all my medical appointments on the same days (pulmonologist, Endocrinologist, surgeon, dieticians etc. the time frame for mine was 1 year...they were not flexible about that at all.

I had my Bypass on 12/11/19 and finally feeling normal. I have not had insulin since the day of surgery.