LacyMay

Hello everyone! I'm in the process of starting this journey, having done all kinds of research before making my first appointment. At my appointment yesterday I was given standard requirements needed by my insurance company, such as 6 months of a doctor supervised weight loss program and 3 years of weights showing a BMI over 40. I told them that this wasn't required by my particular insurance policy, but they really didn't believe me and said until I had proof of that these were my requirements. I called my insurance company again to verify that all I needed was a current BMI greater than 40, and 5 days notice before the procedure was done. I called the doctor's office to let them know this, and that my insurance company said they could call the provider number on the back of my card to verify. For some reason this office does not want to call the provider number, just telling me to forward them the exact policy when I receive it. That's fine, I'll send it to them when I get it, but when asking the doctor's office a question today I was told that even if the insurance company does not require 3 years of weights they will not submit for approval unless they have 3 years of weights. I asked why in the world they won't submit for approval without it when the insurance doesn't require it, and the doctor doesn't require it. I again suggested they call the provider number and they still will not call it, just wanting it in writing because 'in all our years doing this and dealing with numerous insurance companies we have never had one not require the 3 years of weights'. Now, this is supposedly a very good surgeon that does nothing but these types of procedures. Is this normal that they will not call the provider number to get the details on my particular policy so they can stop giving me inaccurate information? Has anyone else experienced this or something like this before?

I agree with you. I've been thinking about it and can't think of any excuse I can come up with for why they wouldn't make that phone call. As much as I like the doctor, the office staff is who I will be dealing with most and if I have to tell them how to do their job it should be a huge red flag. Thanks for your input!

Thank you for the good wishes! I don't mind doing the things that are required by either the surgeon or insurance company. I just took issue with them saying that they would not even submit for approval without the 3 years weights when the insurance doesn't want it, nor the doctor. The insurance company said 'Why would they not at least submit for approval if we don't need it? All that could happen is it would be approved or denied?"

I was celebrating hard when I found d out I didn't have to jump through any crazy hoops for the insurance company! Then the crazy office wants me to jump hoops anyway lol

I was celebrating hard when I found d out I didn't have to jump through any crazy hoops for the insurance company! Then the crazy office wants me to jump hoops anyway lol

I haven't had a BMI over 40 for the past 3 years, more like 38, so I really don't want to give that information to the insurance company if they don't need it, just in case it makes them decide to use it as a reason to not approve. Unfortunately, it was the manager I spoke to last. My insurance company is emailing me the information, which I will forward to the office when I receive it. I just hadn't heard of anyone having a problem where the INSURANCE company has to advocate to the DOCTOR instead of vice versa, which it may have to come down to it seems lol. I've been doing my research and preparing myself for months already, I just hadn't made the initial appointment before now because I wanted to be sure to have my out of pocket expenses on hand, and it's tricky to be able to schedule something like this around my husband's work schedule. After reading so many experiences on this forum and others I had just thought the doctor's office would be the one contacting my insurance to find out what is needed. I loved the surgeon when I met with him, I'm just not very impressed with the office staff so far. I guess I just needed to vent, and wondered if it was normal that they wouldn't want to call to find out specific's on my particular policy. My insurance company doesn't understand why they aren't calling the provider number either. Thank you for the good wishes!