Insurance Approval Question

[Pinky Green 260]

I finished the 3 weight loss management classes in 3 months, the Nutrition class, the cardiac clearance, the psych evalution, all the bloodwork and got a recommendation and clearance letter from my PCP. Now I just have to do the Endoscopy and the Colonoscopy. I am doing that tomorrow and the paperwork on my procedure says that it takes 10 business days to get the results from them. Question - is the endoscopy and colonoscopy required by the insurance usually or is it a requirement of the surgeon so he knows what's going on there before the surgery? In other words, am I ready for them to submit to insurance for my approval or will I have to wait for the Endoscopy/Colonoscopy to get insurance approval? I have Cigna if that makes a difference.

[lollyfidy1965 402]

I had neither procedure done prior to my surgery, but every surgical/insurance program seems to have its own set of requirements to be met, prior to approval. Be thankful your insurance company doesn't require a 6-month, medically supervised weight loss program prior to approval!! ;-P

Best of luck to you!

Laura

[caroless 18]

the endoscopy and colonscopy are necessary from the dr depending on your med history. they arent for insurance. but the dr needs to make sure you dont have polyps or a hiatial hernia or anything before he will agree to do the surgery. it's his requirement to make sure you are good to go before he will set a date. from here, a date must be set before any preapproval can be made by the insurance. they won't even look at it without a surgery date.

[N/A 96]

I have Western Health Advantage grouping with Hills Physicians. Hills required me to take the six month class/weigh ins program, psch evaluation, endoscopy, colonoscopy, EKG, chest xray, mammogram and pap, labwork. I also attended mandatory seminar, support group meeting and nutrition class required by surgeon. Pending insurance approval now. My PCP sent surgical authorization request last week.