Pre-determination letter

[eatoandc 33]

Hi I am brand new to the site although I've been researching lap band for almost a year now. Anyway I have started to get the ball rolling and my insurance company says they will cover 90% of this surgery, all they need is a pre-determination letter frm dr saying that I qualify for the surgery. My BM is at 40 and I have no other major health problems besides being hypothyroid. I am scheduled to go to a seminar in Lubbock next week but I wanted to know who would be the dr that presents the pre-determination letter to my a insurance company? My regular practitioner or the surgeon? This site has been helpful so I thought y'all might give me a better idea about how this beginning part works. Thx!

[DELETE THIS ACCOUNT! 12,703]

Once you go to the seminar and let them know you're interested, the surgeon's office will have staff to help you through the whole process. They will tell you exactly what letters need to come from which doctors as well as any tests you need ahead of time.

Best wishes!

[The Icy One 518]

What Missy said. These WLS practices have the process down to a fine art. They will handle everything, let you know exactly what you need to do, what documentation you need, what tests you need and when and expedite everything. I am in the third month of my four month insurance company mandated hoop jump and so far, the process, while tormentingly long, has been nearly effortless and very smooth.

[eatoandc 33]

Thank y'all that helps I think I'm just getting a little anxious!!

[The Icy One 518]

Nerves are normal. WLS is huge. And getting through the process, even with a surgical center that knows their stuff can be nerve wracking.

[karenlamorena 20]

Hi my name is karen i am 270 lb. And my bmi 51. I have hypothyroidsm ,well in the lab work for the surgery i found out .Today i am 15 days with meds and waiting in pcp office waiting to know if the meds are working i hope they say its better so i can continue with my surgery process

[eatoandc 33]

Hope it goes well! I have appointment with the surgeon next week! I used to be hyperthyroid and had an ablation so now I'm on the other end... One reason it's so hard for me to lose weight.

[karenlamorena 20]

I wonder how hard it will be,.And if I will be able to succed.Only time will say . Hope for the best wish every thing will be ok.

[eatoandc 33]

Hi glad to know there are ppl with hypothyroid on here besides me. Went to first appointment and my office submits letter via fax... Ins co said its alot faster if they submit by phone. How much harder is that for the office to do I wonder. I hate to bug them about it but I want to request them to call instead of fax I'm so anxious to get approved!!

[sandbandster13 0]

I also found out that I have hypothyroidism. I started my meds today. Lapland surgery scheduled for 10/4/13 and I must say I'm having second thoughts and nightmares lol.....all I can do now is pray.

[jesscara1987 40]

Hi I am brand new to the site although I've been researching lap band for almost a year now. Anyway I have started to get the ball rolling and my insurance company says they will cover 90% of this surgery' date=' all they need is a pre-determination letter frm dr saying that I qualify for the surgery. My BM is at 40 and I have no other major health problems besides being hypothyroid. I am scheduled to go to a seminar in Lubbock next week but I wanted to know who would be the dr that presents the pre-determination letter to my a insurance company? My regular practitioner or the surgeon? This site has been helpful so I thought y'all might give me a better idea about how this beginning part works. Thx![/quote']

My surgeons office told me it had to be the PCP or who ever was following your struggle with weightloss. The insurance company doesn't want to see a letter from the surgeon who is trying to sell you an expensive surgery but from someone who will be objective because they have nothing to gain but a healthier patient.

[eatoandc 33]

i see i guess everyone's insurance company is different. mine said they rather have surgeon submit it since that is who is doing surgery and has info they need etc...

[lisacaron 5,075]

Insurance companies differ in the way they require information from everyone. Even if it's the same company there could be different tiers of coverage that have different requirements.

The best thing to do is to call your insurance company and then give them what they ask for. Sometimes the surgeon's office will find out for you.

I like to take an active role in finding out what's needed and getting it to the right places, sometimes there are so many moving parts to getting this done, it can get complicated. I kept a file for myself of all my medical records and tests just in case something was missing I had a copy of it