Insurance Approval Questions

[contrabanded 18]

Hey all,

I am in month 4 of 6 for the pre-op supervised diet before I can apply for surgery approval. With the way things are lining up, I will be approved (hopefully) sometime in December. However, I want to push my surgery date back to January for 2 reasons. 1) I will be able to switch to the low deductible high premium plan my work offers to hopefully make my money stretch a little further and 2) I'd rather start fresh with the new year and after the holidays. Only problem is I know you have to get re-approved for the lap band during a new calendar year even if you were already approved, so I have some questions:

1) How likely is it that I could be denied reapproval after the new calendar year starts? Is that a risk I should be careful taking?

2)I had to call my insurance rep the other day to figure out how much I will have to pay the psychologist I have to see and make sure he is in network. I started to ask the rep questions about the approval process and applying for surgery and she referred me to a "bariatric team" that Humana has. My fear is that if I call them and ask questions about the approval process before I submit the claim with the help of my doctors, that it will hurt my chances of getting approved instead of help.

I would love if anyone has some thoughts or helpful information!

Thanks guys!

[Sojourner 2,446]

This seems to be a situation of having to choose what your highest priorities are. Essentially you have to decide if the change in benefits and coverage with insurance is more important than moving forward with your approval process.

As one who had to have their surgery delayed for a year due to unanticipated medical conditions, my PCP was able to "keep the approval window" open for me longer than most individuals. I had completed my required 6 month supervised diet a year before I applied for approval for my insurance coverage for my surgery.

That said, I also had some additional reasons for choosing to delay my surgery for a month...If I had to do the entire process over, I would still make the same choices. The additional month delay did allow me to go on a long planned family cruise before my son moved to Europe and be in the optimal emotional and health condition possible under the circumstances.

Your best source of information will be to contact your insurance company directly and discuss your options with them.

[FLORIDAYS 3,040]

I cannot speak about the insurance end of it... becasue my insurance (Aetna) didnt cover it. However you spoke about delaying your surgery becasue of the holidays and I just wanted to let you know I started my pre op liquid the day before thanksgiving 2010... had surgery 12/9 so was on liquid the entire month of december! My first bit of solids came on New Years Day 2011.... so unless there is a financially benefical reason to delay... I wouldnt suggest it.

Best of luck!

[contrabanded 18]

I am sticking with the same insurance company, just intending to switch to the higher premium plan. I am prepared to pay for the surgery out of pocket if absolutely necessary, just trying to maximize my benefit. Guess its better to go through it now and see rather than being held up last minute due to red tape. Thanks guys!