If Consult Approved Does That Mean Surgery Will Be Approved?

[Lulu1513 14]

I have anthem blue cross *** with sharp community medical group and I keep hearing my medical group would require a 6 month diet but my insurance doesn't. When I first asked for the referral for surgery it was denied then I filled out a form listing past diets I tried and I was approved for the consult with the surgeon. Does anyone know if that means the surgery will get approved?

[Mz_Elle 23]

No it does not. Your health plan has approved the consult only, which is basically and authorized office visit to dialogue with a surgeon about options and what is best for you given your expectations. Based on the consult, then they will proceed with getting the surgery approved. It sounds like you're going to have a lengthy process to get approved.

I'd recommend you check your plan to 1st determine if your employer considers the procedure to be a "covered benefit." You'll be surprised how many ppl start the process only to find out that WLS or the particular type they are seeking isn't even covered by their health plan.

Good luck to you!

[Lulu1513 14]

I did call my insurance and the surgery is covered. They said I would just need to meet the requirements of my medical group. I just can't seem to find out what the medical group requirements are.