Approved Or Not...

[AnnMarie49930 25]

I am pretty easily confused so maybe someone here can help me understand. My PCP contacted the surgeons office about WLS. The in turn sent me a big packet with all kinds of information.I attended the seminar May 21st. I called my insurance company to see if they covered the psych evaluation. Which they do with no co-pay ( Yay), I asked if they cover the cost of the surgery and the $80 fee for this and a $400 fee for that ( They do, no co-pay again! A good day for me so far!! ). The insurance company told me they would cover if it's medically needed. To which I replied " I have a BMI of 58. I am EXTREMELY overweight. I have sleep apnea. I know I am not healthy. I need to loose weight" .Anyway. she said the the insurance covers all things. I could call and make the appointments needed. I called about the psych eval and they need to call me back to schedule that. I then called the surgeons office and asked what my next step was. The lady told me that they are weighting on the paper work I sent in. I figured while I have her on the phone to ask questions regarding insurance. She said that my insurance was approved already, If not, she couldn't talk to me. (she didn't come across as being the friendliest person in the world) That is where I'm confused. Am I approved for the entire procedure or the office visit or what?

[Nikki Riviotta 33]

Sounds to me like you are approved. Congrats!

[NWgirl 574]

No, I do not think you are approved for surgery. I think the office lady meant that they accept your insurance type. The insurance company rep you spoke with would not have been authorized to approve you, but to tell you exactly the qualifications needed for surgery to be approved. If you are with an H-M-O (where you must receive referrals to see specialists), then you would need to be referred/approved to do the pre-op visits.

When the surgeon's office submits the paperwork for pre-approval, you will know. You have to complete all required testing (such as sleep study, blood testing, etc) to find or verify any co-morbidities before you are submitted. They most likely don't even have your beginning weight, as you just attended the seminar.

[honk 780]

My insurance sent me an approval letter directly.

[AnnMarie49930 25]

I'll just have to wait and see.