Upper GI question

Syrah · December 28, 2006

Hello all, I am new here!

I am scheduled for an upper GI tomorrow. I have heard that this may not be covered by insurance. Has anyone else experienced this? My banding surgery IS covered by insurance / has been approved. The only thing I have left to do is the upper GI (I did the MMPI already).

It seems odd that the surgery is covered but a diagnostic test being done FOR the surgery is in question. :cry I was told that this surgeon checks everyone for reflux before he'll do the banding.

Thoughts?

Oh, and this looks like a great board. There is a lot of great info here. :biggrin1:

Alexandra · December 28, 2006

Hi Syrah!

The reason your upper GI may not be covered by insurance is that it's not a diagnostic test ordered because you have symptoms. Insurance typically only covers things that are medically necessary to diagnose or treat disease; this seems like just a precautionary thing your surgeon does for his own reasons and as such, it may not be covered.

I think it's very unusual for a surgeon to require an upper GI test on all of his patients, including those with no symptoms or history to suggest a problem. If I were more cynical, I'd wonder if he has a part-ownership of the testing facility.

shutuplena · December 29, 2006

My surgeon required an upper GI too (endoscopy) along with many other tests as well. It does seem odd that it wouldn't be covered. Is the doctor referring you to a gastro doctor who maybe doesn't participate in your plan? Check with your insurance co and find out what their procedure is. They should cover you.

soniacan · December 29, 2006

i think i had to pay almost 200bucks for mine. i was annoyed because I was told I had to go to Rush Hospital to have it done and not at the surgical center. so i make another appointment and go... and then get billed anyway. If theinsurance wasn't going to pay for it I wish it would have all been done at the same time as my pre-op testing. sillyness.