Referral issues-wtf?

[JennyBeth 127]

So my 1st appt is on Thursday with the surgeon and it also covers the EGD that he requires. My PCP mailed a copy of the referral to me and I opened it last night and along the bottom it says, "Only lap band is covered at Loyola. If bypass is recommended treatment then patient must be directed to Silver Cross." Loyola is where my PCP directed me and where my surgeon goes through! He doesn't operate at Silver Cross hospital as far as I know. No where on the referral does it mention sleeve gastrectomy on it and I definitely don't want the band or bypass! Of course I open this on a Friday night and now I have to wait until Monday to get my questions answered! I asked BCBS to make sure they cover the sleeve before I even started this process! Now I'm worried I won't get approved for the sleeve! What do I do now?

[JuliannaJ 83]

I had to switch docs at first too because the first one did not do the sleeve. The office will have to be the one to tell you but the sleeve seems to be the most popular now of all of the three procedures so if a bariatric facility wants to succeed, they probably should offer it.

Does the doc have a website or is on obesity help? Maybe google him and see if there is anything about him or look on here. It may be that the paperwork is a little outdated and he does do the sleeve.

[erp 2,016]

I switched Dr.s at one point as well. It's a small bump in the road but shouldn't cause much delay. In my case, I had my insurance company send me a list of their Dr.s, then I called each one and asked that procedures they have performed. Based on that I called my PCP and she issued the referral to the new Dr.

[JennyBeth 127]

The surgeon does do the sleeve, but the referral only mentions the lap band or bypass. It doesn't mention the sleeve at all! Now I'm worried that the insurance (BCBS) will say they only cover lap band/bypass even though they told me verbally they cover all bariatric surgery with no exclusions. I don't want to go for the consult and pay the $70 co-pay and then not be able to use him! I have already done the seminar and I really like the surgeon. I'll have to make some phone calls on Monday morning and get things straightened out! Frustrating!

[theshrinkingchef 61]

I have bc/bs and it never mentions the sleeve in any of their literature(2012). I know that it a fairly new procedure... 8-9 years old... And it wasn't until recently that they started to acknowledge vsg as an alternative. I got approved, worried that they wouldn't cover it. I'd ask the insurance company whether it's covered. My insurance liason at the clinic was very knowledgeable and could verify that info for me. Also, I didn't require a referral. I just walked in off the street and began the process. My pcp doesnt even know I'm doing this. I asked all of my questions before I shelled out one nickel. I'm with you, I'm not going to waste my time if I dont have to. Good luck!

[Nicole 2013 44]

The surgeon does do the sleeve' date=' but the referral only mentions the lap band or bypass. It doesn't mention the sleeve at all! Now I'm worried that the insurance (BCBS) will say they only cover lap band/bypass even though they told me verbally they cover all bariatric surgery with no exclusions. I don't want to go for the consult and pay the 70 co-pay and then not be able to use him! I have already done the seminar and I really like the surgeon. I'll have to make some phone calls on Monday morning and get things straightened out! Frustrating![/quote']

The approval letter i got says bypass but my dr said we're sleeving just how some insurance words things good luck

[JennyBeth 127]

My PCP's office knows (as well as the surgeon's office) that I want the sleeve. Neither of them mentioned it and they both saw the referral. I'm probably getting freaked out over nothing. I just want this surgery SO badly it gets me in a panic to think of something preventing it from happening! (I had to have a referral from my PCP because I have H M O insurance and they'll only approve it if my PCP deems it medically necessary. If it wasn't required I would never deal with this referral CRAP!)

[Mastiff_mama 171]

My surgeon operates out of about 6 hospitals, so don't stress until you find out!

[Nicole 2013 44]

!

[Nicole 2013 44]

The surgeon does do the sleeve' date=' but the referral only mentions the lap band or bypass. It doesn't mention the sleeve at all! Now I'm worried that the insurance (BCBS) will say they only cover lap band/bypass even though they told me verbally they cover all bariatric surgery with no exclusions. I don't want to go for the consult and pay the 70 co-pay and then not be able to use him! I have already done the seminar and I really like the surgeon. I'll have to make some phone calls on Monday morning and get things straightened out! Frustrating![/quote']

Ooops did you find out?