Changing surgeons after getting approval from insurance

[gomezk2 24]

Wanted to ask anyone if they had changed surgeons after getting approved for gastric sleeve by the insurance. Has anyone had problems with it? Also has there been a timeline of how long the wait is prior to getting the ok from the insurance.

The situation is that my wife got approved by BCBS of NJ for her sleeve but now wants to get it done by another surgeon and she is afraid that the insurance will make things complicated and she loses out on getting her sleeve done.

[NikkiDoc 312]

I have worked in insurance for 26 years. Generally the approval for a surgery like this is based on medical necessity and therefore it does no matter who performs the surgery. However for WLS some insurance companies require it to be done through a Centers of Excellence. Therefore it still would not be restricted to the particular doctor as long as you have it done by a Centers of Excellence surgeon. Medically necessary is medically necessary.

Odd thing on Centers of Excellence are programs/surgeons the insurance company has designated as COE and not necessarily ones that hold that designation by some official organization. In other words the list of COEs can between insurance companies and it isn't as cut and dry as all network providers are COEs.

That does not mean that you might not have to jump through a few more hoops. The new surgeon may have additional pre-op testing and will likely want to resubmit everything to your insurance so they have the approval also. My surgeon did not require me to see a pulmonologist or have a sleep apnea study. The other surgeon requires all of his patient's to be either cleared by a pulmonologist or have sleep apnea study. I know they have a few other differences in the pre-op requirements.

[Jersrose43 837]

Your new surgeon will just have to call the insurance and reference the authorization and change the performing surgeon.

Def be cautious of the change in hospital due to center of excellence.

[Ohsosleeved 13]

Did everything go smoothly? I am in the same situation. I have been approved but the surgeon's office cancelled my surgery due to 15 lb weight gain since August. They are requiring me to lose the weight before they will put me back on the schedule. This would be fine if I wasn't starting a new job in a couple of months and NEEDING to have surgery done before I start. It's either now or wait another 6 months and that is out of the question. It took me 6 months of a preop diet, another month before I got insurance approval, scheduled a month out only to be taken off the schedule a week before my surgery date. Taking 3-4 weeks to lose the 15 lbs and waiting a month before surgery will kill my timeline. I feel like I need to get the ball rolling with another surgeon ASAP. I really don't have time to wait. I have BC/BS of Michigan. Please help!

Wanted to ask anyone if they had changed surgeons after getting approved for gastric sleeve by the insurance. Has anyone had problems with it? Also has there been a timeline of how long the wait is prior to getting the ok from the insurance.

The situation is that my wife got approved by BCBS of NJ for her sleeve but now wants to get it done by another surgeon and she is afraid that the insurance will make things complicated and she loses out on getting her sleeve done.

[byebyefat 262]

I switched my surgeon, the insurance coordinator from my Dr's office, did all of the phone calls and paperwork, and I had no delays , I switched after I got approved 2 and half weeks prior to surgery, I was sleeved

[Ohsosleeved 13]

I switched my surgeon, the insurance coordinator from my Dr's office, did all of the phone calls and paperwork, and I had no delays , I switched after I got approved 2 and half weeks prior to surgery, I was sleeved

Thank you!

[B_D 54]

Hi there I just did this, the original surgeon's office had everything they needed for 5 months and never submitted it. I found out they finally submitted my information March 29th and I had an approval 2 days later. I was not comfortable using that office and was quite upset so I went to a different surgeon recommended by my doctor. The original office had to contact my insurance and void the authorization and then the new office was able to submit for approval. Took 3 days, no problems and my surgery has been scheduled for May 3