If you were denied due to a WLS exclusion in your plan ...

[Candle 11]

How did your insurance company handle the doctor bills for the pre-op tests?

The sleep study, cardiac evaluation, thyroid testing, etc ... did they cover those things because they are tests that could have needed to be done anyway, since you are over weight?

Or did they deny the claims because they were pre-op tests for "bariatric surgery"

I know I have an exclusion and I don't want to find out down the road BC/BS won't cover these bills. (I am switching my insurance co before the surgery. A policy that covers it.)

[lisah25 3]

My sleep study was covered, that was really the only test I needed since I had had my annual physical not that long before deciding to have the band. My PCP referred me, and we had talked about it before anyway because I suspected I had apnea, so my insurance covered it and they are paying for the CPAP.

[Candle 11]

Thanks for the reply

Doesn't it seem like this is all so much more complicated than it should be? lol

[lisah25 3]

Thanks for the reply

Doesn't it seem like this is all so much more complicated than it should be? lol

LOL - no kidding!

I think it's all part of proving to someone somewhere that you really really do want the band.

[Candle 11]

Anyone else?

[faithmd 14]

My suggestion to you is to make sure your PCP does NOT write anything about the consults you get referred to as being pre-op for bariatric surgery. If you are seeing your PCP for a physical exam, then the thryroid testing could be part of that physical, and the sleep study and cardiac testing could be because of complaints you had at that physical.

[Mvpo8961 1]

When I started my journey in November 2005 I had Aetna insurance. They paid for all the preop testing minus the copay but the surgery itself was an actual exclusion on my policy. My PCP referred me to the surgeon and he ordered the preop testing.

Go figure.:omg:

Myra

[demmemoon 0]

Anyone else notice that all of the above that replied have some kind of Simpson avatar?

Dooooohhhhh........

[Candle 11]

I've got a few apointments coming up.

*fingers crossed*

[Lap_dancer 8]

How did your insurance company handle the doctor bills for the pre-op tests?

Covered the following..*I'm fat so diagnosis obesity is a no brainer.

The sleep study,

cardiac evaluation,

thyroid testing,*blood chemistry panel) etc ... did they cover those things because they are tests that could have needed to be done anyway, since you are over weight? &&&& YES!

Or did they deny the claims because they were pre-op tests for "bariatric surgery"

^^^NO. Non bariatric patients have these tests on a regular basis.

I know I have an exclusion and I don't want to find out down the road BC/BS won't cover these bills. Blue Cross Blue Shield of Florida HMO Health Options covered all of my tests.

[late 0]

I also have bcbs (tx). I talked to them at least 4 times and each time i was told that wls was an exclusion on my policy. I decided to go ahead and try because my surgeon's office said that they spoke with them and used different diagnosis codes and bcbs told them it was subject to medical revue. So i did the 6 mos dr supervised weight loss with my surgeon, which basically consisted of me showing up once a month for six mos. getting weighed, blood pressure taken, and temp taken. THen I went and did the psych consult ($30 copay), pulmonology appointment ($30 copay), cardiology appt. with a stress test and ekg (2-$30 copays) and a meeting with a dietician ($98). My surgeons PA still didn't think i would be approved because i have no co-morbidities and a bmi of 42. We sent it in anyway and prayed. One week ago I called and found out that I had been approved. I think i am still in shock, but I am so excited. I already had financing set up because I didn't think it would happen. I hope this is helpful for you. Good luck!

[Candle 11]

Just got the explanation of Benefits letter on my surgeon consult ... I only had to pay the co-pay of $30.00!!

Woo-Hoo!!

[cyndilou29 0]

I am in the same situation and freaking a little as it gets closer. I am taking a loan from my 401K to cover the surgery but I'm having second thoughts. Has anyone here NOT had the pre-op stuff covered with a WLS exclusion? I have Horizon and I hear they are pretty bad about this.

Also, my company is self-insured - does anyone know if that increases my odds at all? When you appeal, does the appeal go to the insurance company or my employer? I would have assumed it would go to the employer as they would have to pay for it but I haven't been able to get a clear answer on that. Any thoughts?

[tkw13 0]

i am in hr and our company is self funded...any appeals go to insurance company. we never see that and no one else should espically due to hippa. our insurance won't cover the lap band, but all of my pre test have been covered due to hypertension, hernia, etc...

[tkw13 0]

also, my dr called today. my insurance will pick up a portion of the surgery due to the umibical hernia the doctor could feel. almost everyone i know that has had this surgery had a hernia. your insurance should pay to have that repaired and should pick up a portion of the hospital and dr cost. by the way, my insurance excludes any weight loss surgery. i can easily come up $5000 better than the $14,000.