Insurance question/issue

[Jenuine629 24]

Hi everyone....I'm new here and have a question. I finally decided to do gastric sleeve back in January. Began getting my ducks in a row by seeing primary doc, nutritionist, and psych eval. (Like GI surgeon recommended at my initial visit back in 2013 --- I had waited a bit because I wasn't sure if I wanted sleeve or not). Early march I see GI surgeon again, sends me for endo. Unfortunately, my primary had only four years of documented weights. Per surgeon I needed five. So from various mds and offices, I finally tracked down 5 years worth of documented weights. Sent those records off to surgeon this week. Got an email tonight saying that she won't apply to insurance company until I have six months of documented weights and plan of diet/exercise plan (can be back dated) from primary md. Problem is that I don't have six months of past records or weights. I'm fairly healthy and primary md only weighs me at my physical which was last July. My surgery now is scheduled for June 4...but if I need six months of a plan, I won't be able to do it until October. Why didn't the GI office tell me sooner? I'm heart broken and discouraged...almost don't want to go ahead now with the surgery. I feel let down. I did so much work and would have done this sooner. Any suggestions? Anyone have this issue?

Thanks for reading

[mentalistfan 189]

I'm aggravated too, but I'm not going to let it stop me. I called my insurance company first to see what I needed. But, the surgeons insurance coordinator acts like I got the wrong information. I have went to the seminar, got my EKG, chest x-ray, labs, and saw my PCP for a letter of recommendation and my first weigh in and flow chart. The part that bothers me is my insurance says I don't need the six month flow charts! I go for psych evaluation on April 30 and see the surgeon...I'm going to take documentation with me...I want my surgery over the summer while my daughter is on summer break. My insurance got rid of the six month rule over a year ago and I don't want to wait if I don't have to.

[jtickle 295]

I had the same problem with the insurance coordinator not believing that I did not need a 6 month diet. I finally had to get my requirements in writing from the insurance company to prove to them that I didn't have to do the 6 months. I started all this on March 3rd and my info is being sent to insurance on Monday. Hopefully they give an approval in a decent amount of time.

[greensleeve 457]

Call your insurance company and ask them what their requirements are. It's not up to the coordinator, it's up to your insurance company.

Some of these people who work for surgeons are just so rude.

[mentalistfan 189]

Ok, I have talked to my insurance company about eight times and forwarded an email to the surgeons office and the insurance coordinator wouldn't get on the phone...I can't make these people believe me! So, I emailed straight to the insurance coordinator today...I feel like I'm going to make her mad but it's all in black and white, she needs to quit acting like a know it all....my insurance company abolished this criteria a little over a year ago. I'm doing all I can and trying not to make them hate me in the process. Next step if I don't hear from her...tell the Surgeon on my visit! I'm still going to get the flow charts just in case, I don't want to start over.

[mentalistfan 189]

I'm confused on why a GI Dr. Is telling you what you need...not sure what a GI Dr. is unless a stomach Dr. You should have called your insurance and talked to someone from the surgeons office on things they both require.

[jujubslim 95]

Honestly if my biggest obstacle was the surgeons office I'd find another dr.

My surgeon's practice was on the ball. They were fully aware of what criteria was needed by multiple insurance companies. They coordinated my nutritionist visits and psych eval. Everything went smooth. My first appointment was dec 18, my surgery was March 17 (my ins had a 3 month medically supervised diet requirement)

[greensleeve 457]

Ok, I have talked to my insurance company about eight times and forwarded an email to the surgeons office and the insurance coordinator wouldn't get on the phone...I can't make these people believe me! So, I emailed straight to the insurance coordinator today...I feel like I'm going to make her mad but it's all in black and white, she needs to quit acting like a know it all....my insurance company abolished this criteria a little over a year ago. I'm doing all I can and trying not to make them hate me in the process. Next step if I don't hear from her...tell the Surgeon on my visit! I'm still going to get the flow charts just in case, I don't want to start over.

I would change surgeons if I were you. Who is your surgeon anyway?