Pre-op tests that I am having anyway

[Travelmego 235]

Even though my insurance won't pay for the sleeve , it will still pay for all the pre-op tests that USA docs usually require before sleeve surgery. SO, I got the list of what my local one requires and am getting them done even though the Mexican surgeons don't require them.

These include:

Upper G.I (i think this is the endoscopy test....not sure)

Ultrasound of liver

Cardio test (not sure what they do, I think an EKG)

Pulmonary test (again not sure, will update post test)

sleep apnea test

[vivitampa 4]

That is great! I plan on doing the same tests as well before heading to Tijuana.

I am getting my surgery for the Sleeve in November.

[Travelmego 235]

Hey congratulations. Did you set a definite date and send in your deposit? I am looking for the first week of August. I don't know why I put this topic. I guess I just wanted to put a list so people know what the 'usual' tests are.

[vivitampa 4]

Oh yes I most certainly do have the date set. I set it for Aug 5 nearly 3 months ago when I sent in my deposit. I wanted to set my date so I could buy my airline

ticket and arrange my days off at work Most people don't plan so far ahead but my situation to was that I don't have the $4500 cash for the surgery yet. I am still saving up.

I've researched my doctor a lot and continue to after sending in my deposit learning more about him with all the stories I find out about his current patients. I especially have learned SO much on Facebook on the Sleeve Gastrectomy and Weight Loss Surgery groups.

[Travelmego 235]

Hey, I am looking at the first week of August too. I am looking at Dr. Garcia, Dr. Illan and Dr. Quionones now. I have air miles but I want to get the tickets right away so I can be sure to get the seats I want. There is another lady on here that is also going that week. I think we will all be staying at the Marriott. I want to go a few days early (maybe) and hang out at the beach some. I am not sure thought because the all liquid diet might just make it miserable.

[Kindle 8,667]

Just curious, but doesn't your insurance company require a REASON for having all those tests before they will approve to pay for them? Doctors have to submit billing and diagnostic codes to the insurance company. I ask because only some of my routine post op bloodwork will be covered by insurance. My PCP can submit certain tests under a wellness check, but he can't really explain the specialty Vitamin deficiency tests without mentioning the surgery or flat out lying about a differential.

[Travelmego 235]

But why would we have to lie about the surgery? My pcp is ordering the tests for preparation for bariatric surgery. I don't see why the insurance company would care if I have surgery or not. If blood work is needed, it is needed. I will double check though. Even if they would refuse for bariatric- I have plenty of non - bariatric reasons for getting the tests done.

Edited June 3, 2014 by Travelmego

[Kindle 8,667]

That's great that you can get these tests paid for. Does that mean your insurance does cover WLS? And also great your PCP is on board with your decision. Unfortunately my insurance (Blueshield) excludes WLS, including any type of weight Loss treatment, counseling or complications of WLS, so any reference to it on claim submissions would result in the claim being denied. I went through the same thing with my fecal transplant, too. Since they wouldn't cover the fecal transplant itself (because they consider it experimental) they also wouldn't cover the bloodwork, stool tests, or colonoscopy that were required before the transplant. These things would have been paid for if they were done for an "approved" procedure.

Hope you get all A's!

Edited June 3, 2014 by Kindle

[SnohoGal98296 371]

But why would we have to lie about the surgery? My pcp is ordering the tests for preparation for bariatric surgery. I don't see why the insurance company would care if I have surgery or not. If blood work is needed, it is needed. I will double check though. Even if they would refuse for bariatric- I have plenty of non - bariatric reasons for getting the tests done.

I am self-pay too, my insurance excludes bariatric surgery, to get your tests paid for the Doctors code the comorbidities, like heart burn, high blood pressure, blood work results, etc. sleep tests are based upon visuals like your neck size and being tired, they find a way and none of it is unethical because these test are not WLS specific.

[Travelmego 235]

Do I need to have my doctor change the reason for the tests? I had him put for bariatric surgery on the referral. However, I can surely need these tests just in and of themselves for diabetes and being overweight. My insurance does cover bariatric bypass but not the sleeve. However, I don't want the bypass hence Mexico. Also, it is a pain trying to get accepted for the surgery anyway.

If he already did the referral for bariatric, can I go and change it? Or will they be like, 'nice try but too late you already said bariatric'?

[CandyPants81 94]

Thanks for posting this topic. I am now thinking maybe I should have a couple of tests as well. One girl on another forum states that an ulcer was found (which delayed her surgery) during an endoscopy, so it's probably a good idea to have some of these tests before I head in for surgery next month.

Good point about the insurance too. Bariatric surgery is an exclusion in my insurance policy, so I'm not sure how that would go as far as Humana covering the tests. I will speak to my doctor about it.

C.

[Travelmego 235]

candy - i would say it can't hurt, might help.

Darn it! I have a feeling I need to call the referral lady tomorrow and ask her to send them AGAIN but coded for like just the regular stuff. My insurance pays for gastric bypass but with it being a pre-approval thing - I just have this feeling that @@Kindle and @@SnohoGal98296 are right and I need to have it redone. She is going to hate me lol.

Edited June 4, 2014 by Travelmego

[Kindle 8,667]

I'm sure your doctor and his billing department know what your insurance does and doesn't cover....more so than I do. You would have to have all those tests and submit results to be approved for the bariatric surgery they do cover, so it's probably OK. My situation is completely different since my insurance excludes all WLS, so obviously they wouldn't pay for any tests related to WLS.

[Travelmego 235]

Hmm...I will call and ask. They do cover wls BUT it has to be pre-approved (as probably all do). I am not sure they will cover it without having the whole thing pre-approved. I will call and ask today.

[SnohoGal98296 371]

I am going to go out on a limb and say that the cost @@Travelmego insurance would want pre-approval for is the WLS, not the pre-op tests. In fact I bet they are betting that something in the pre-op tests will exclude the surgery - because they are Dr. Evil like that :-D

Good Luck and Best Wishes Travelmego!