Insurance coverage - how do you know?

[UpandAtom 126]

Hi everyone. I'm brand new here and so glad I found these forums on Bariatric Pal. I was only considering the band and when I had my initial surgeon consult he indicated that he hated the band. Too many problems and low long term success rate. So okay, sleeve it is!

My question is, how did you all find out what hoops your insurance company was making you jump through to get approval?

I have heard of people needing six months of supervised diets (ugh been there done that), people needing various tests, wait times, psych Evals and god knows what!

How do I find out all this? The surgeon or nurses mentioned some testing needs but not the rest and my insurance company said I was covered but that the Doc had to call first for approval. So how did you all find all this out before going to far?

[Clexie 3]

During the initial seminar, the office people requested that we contact the insurance company to find out if it was on your plan and to get the specific details. I did call them and they sent me a checklist of what was needed. Also found out that my previous attempts at weight loss within a certain time period were acceptable for the six months. Since I had my Weight Watcher weigh in books, those worked just fine for mine. I have BCBS of MI. Some of the other requirements were the office's and not the insurance.

[one_more_time 145]

Where I work there are two insurance providers for the "medical" part of our coverage (Aetna and BCBS). I already had dealt with Aetna before and I know they are sticklers for "hoop jumping". I have a co-worker who chose them and she is actually having her surgery the same day/same facility we just have different doctors. She started her process (with Aetna) way back in September. They required her to do a 3 month nutrition ordeal with weighing in, going on a 2 week liquid diet prior to surgery...etc. etc. I was still unsure about the surgery around the holidays so made my consult for January to give myself time to think about it... At any rate.. I called BCBS after I made my consult appt. and the the rep told me THE ONLY requirement was my BMI...if the doctor said it was too high...that was good enough for them.

Bottom line it depends on your employer and what company your employer has chose to cover you. Some companies request "exclusions" when it comes to Bariatric Surgeries ( happen with one of my exes). While others will pay but they will have you go through a few "motions" to make sure you "qualify" first before they will pay.

It took my co-worker about 3-4 months just to get her surgery date for February 10th... it took me about 2-3 days. So before you even choose a surgeon... I would call the insurance company ask about coverage requirements ( to confirm it is a covered procedure with your policy) and once you find that out and choose your surgeon.. then make sure he/she is in network so you can get the most coverage without paying out of pocket. This is my second WLS... I am revising a Gastric Bypass from 2005 to a Gastric Sleeve.

Edited February 7, 2014 by one_more_time