About changing surgeons after insurance approval?

[SnowDaisy 73]

Just wondered if anyone can help me with this.

I would like to know if it is possible to change your surgeon once you get approval from your insurance company?

Would you have start completely from scratch, like meeting the BMI requirements. Or will the start weight/BMI that my PCM and current surgeon have on record count? I have lost weight as per my current surgeons request that puts me a little under the criteria for bypass.

There are a few things that I'm not happy with right now...in fact I'm a bit scared.

All opinions welcome

Xxx

[SnowDaisy 73]

Any advice?

[LI Gemini NY 607]

I almost had to change surgeons....call the insurance company. I have HIP, they said I just had to have the new surgeon use the same approval code. Also call the surgeon you want to change to...see what they want, you'd probably have to do the seminar and one on one consult again.

I was attempting to change because they wanted to schedule me for September when I finished by requirements and where approved in June.

As soon as I called and asked to have my file faxed somewhere else they gave me a date for 3 weeks out...so I stayed.

Good look

[SnowDaisy 73]

I almost had to change surgeons....call the insurance company. I have HIP, they said I just had to have the new surgeon use the same approval code. Also call the surgeon you want to change to...see what they want, you'd probably have to do the seminar and one on one consult again.

I was attempting to change because they wanted to schedule me for September when I finished by requirements and where approved in June.

As soon as I called and asked to have my file faxed somewhere else they gave me a date for 3 weeks out...so I stayed.

Good look

Thank you so much for your reply.

Well done you...So it is actually possible, that's such good news to me. I have a lot to think about.

Thanks again x

[Bandista 7,466]

A good first step to whatever you do is to get a copy of those medical records. You will have to fill out forms, etc., but what you want is a copy of what was sent to the insurance company, documentation of all your visits, etc. Everything, just in case. There are four parties -- you, the first surgeon, the new surgeon and the insurance company. The new surgeon's staff should be able to acquire the necessary paperwork and then deal with the insurance company but having your own set of records is a good backup should there be delays, etc. I wouldn't think a change of surgeon would make any difference to the insurance company.

I am familiar with the BMI issue. My insurance company required a 40 or above with no exceptions for high BP, apnea, etc. I was so stressed about that. Good luck to you as you figure out your next steps. Take some deep breaths.....

[kimk1999 450]

If something is going on and you're no longer comfortable with your surgeon, I'd recommend to switch now no matter if you have to redo everything. This is surgery. It's not a haircut you can change or redo the same day. Your health is utmost important.

It seems like the other poster said you have some options and won't be significant delay. Your X-rays, blood work and EKG have to be within 30 days of surgery so I think if you move now you might need to redo those tests.

[SnowDaisy 73]

If something is going on and you're no longer comfortable with your surgeon, I'd recommend to switch now no matter if you have to redo everything. This is surgery. It's not a haircut you can change or redo the same day. Your health is utmost important.

It seems like the other poster said you have some options and won't be significant delay. Your X-rays, blood work and EKG have to be within 30 days of surgery so I think if you move now you might need to redo those tests.

Thank you for you input....I'm well aware of the fact that I'm not trying to change a haircut.

[SnowDaisy 73]

A good first step to whatever you do is to get a copy of those medical records. You will have to fill out forms, etc., but what you want is a copy of what was sent to the insurance company, documentation of all your visits, etc. Everything, just in case. There are four parties -- you, the first surgeon, the new surgeon and the insurance company. The new surgeon's staff should be able to acquire the necessary paperwork and then deal with the insurance company but having your own set of records is a good backup should there be delays, etc. I wouldn't think a change of surgeon would make any difference to the insurance company.

I am familiar with the BMI issue. My insurance company required a 40 or above with no exceptions for high BP, apnea, etc. I was so stressed about that. Good luck to you as you figure out your next steps. Take some deep breaths.....

Thank you for your response...it was really helpful.

It's really helpful to know that it's not necessarily going to be a "yes or no" answer to my question....I'm glad that there are options.

Xx

[moviechick00 23]

I would suggest calling your insurance company. They will tell you if a new predetermination is needed. Most of the time the original request is all that is needed as medical ness has already been proven. They may just need the name of the new doctor. If you have HMO you may need a referral from your pcp to the new doctor. Hope this helps.

[kimk1999 450]

Thank you for you input....I'm well aware of the fact that I'm not trying to change a haircut.

Sorry I hope it didn't come out wrong... (Joys of text vs face to face). I was just trying to suggest that your comfort with the surgeon should be more important than waiting a while to get establish again and a new surgeon to perform it. At one point I had doubts about my surgeon and thought about switching but I didn't. She didn't to anything wrong and it all went well, but part of me wishes I would have researched different doctors better and more thoroughly. I mostly didn't switch as I did like her but I was worried about the calendar and a delay.

[moviechick00 23]

Sorry I hope it didn't come out wrong... (Joys of text vs face to face). I was just trying to suggest that your comfort with the surgeon should be more important than waiting a while to get establish again and a new surgeon to perform it. At one point I had doubts about my surgeon and thought about switching but I didn't. She didn't to anything wrong and it all went well, but part of me wishes I would have researched different doctors better and more thoroughly. I mostly didn't switch as I did like her but I was worried about the calendar and a delay.

I completely understand and am with you on going with your gut. I didn't go with my gut and it got me a revision. :/

[CBT 450]

Once your insurance approves you, generally that approval is good for two years. If they require a center if excellence that's what you have to pay attention to when selecting a new surgeon. That and that s/he is in network.