Insurance approval

[auttinicole 23]

Hi! My 6mo diet and all the information was submitted for approval last week! I'm wondering if it's too soon to call my insurance to make sure they have everything they need to make a determination. Did anyone on here call their insurance? If yes, how long did you wait and what types of questions did you ask? Thanks!!!

[dede0314 356]

I called my insurance like two days after my paperwork was submitted.

[ASUgrad 61]

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Edited October 18, 2015 by ASUgrad

[auttinicole 23]

I just found out my information won't be submitted until today so that sucks. And then my insurance confused the hell out of me by telling me they don't do pre-authorizations for wls and that I would have the surgery first and then the information would be submitted to claims. I've been on the phone back and forth all morning between the weight loss clinic and my insurance. Finally the insurance coordinator from the weight loss clinic informed me I was speaking to a claims person who had no idea what she was talking about and that they were submitting everything today. So calling insurance gets me no where and now I'm anxiously waiting. Damn Carefirst BCBS.

[Zugehily 0]

if i was doing a diet by myself for more than 6 month doing herbalife and xyngular shakes, that you guys think the insurance approve that or i have to start a diet with my surgeon.

[dede0314 356]

@@auttinicole I've never seen where they performed WLS before getting approval. I wouldn't take the chance. You don't want to take the chance of being left with the bill. I would call the insurance company and speak to someone higher up and get the information.

[dede0314 356]

@@Zugehily Most insurance companies require a physician documented weight loss program. I don't think doing your own diet without a physician documentation would work. But you can call your insurance to confirm.

[meljea8 21]

@@auttinicole - if it gets sent today call on tomorrow to see if it was received. Once the insurance company says they have it, then call on Monday for status.

Get names, dates, document what is told to you, the time of the Call, and the record #of the documentation for each time you talk to the insurance company. If you didn't get that the last time get from the when you call tomorrow. It will help you with the process. I kept mine in a notebook just in case.

There could be some confusion, which the surgeon's office can clarify for you.

The insurance company may not do a pre-auth but they could need a pre-certification or pre-approval before you have the date set for the surgery.

[meljea8 21]

I have BCBS and I would have been approved in 3 days from the insurance company receiving my info, but they said they needed more documentation. Overall I was approved within 13 days. I had to see a pulmonary dr & have a scope done. The scope is scheduled for 10/13. Once that's complete I pick my surgery date. ????

I know it's confusing & frustrating, but it will happen for you once the insurance gets your info.

[meljea8 21]

@@Zugehily - I agree with dede0314 if any insurance company requires a 6-moth diet it's a physician supervised diet for 6-monyhs straight, no lapse or you have to start over. Call your insurance to make sure that you are required to do that though. Document, document, document every call on who, when, time, & record # of each call from your insurance co. This is to make sure your info matches hou surgeon's info.

[cj76 43]

I called my insurance company before I ever called the bariatric clinic. I knew what they required from day 1. (Bmi, co-morbidities, psych eval & 3 nutrition counseling sessions) I had all appts set up with clinic before I even went to seminar & had my consult. My last nutritional appt is dec 11 & we are shooting for a dec 18 surgery date. My insurance co said they could take up to 30 days to approve it & suggested that after my 2nd counseling session that the clinic should send all my info & the 12/11 appt so it could be "pending" & I'd have a jump start. Communication has been key & very helpful

[auttinicole 23]

I was approved!!!! I got the news today!! My surgery is scheduled for 11/18/15!!!

[mistybunton 14]

Just curious what did your guys 6 month of medically supervised diet consist of ...that's what I have to do. I'm just anticipating my first appointment with the surgeon on the 23rd!

[hollybower 122]

Misty, all my insurance required was that I see my dr once every 30 days and talk about NOTHING AND I MEAN NOTHING but my weight! How it affects my daily life blah blah blah...it's basically a bi7ch fest about how fat I am for a few minutes. Next she asks what are you going to change this month to try to lose some? Last month I said "I'll ask for non fat milk in my lattes and walk up and down my street a few times a week." She then suggests a low carb diet and I leave. Easy peasy! BUT, whatever you weighed at your PCP office, DONT GO OVER!! You can lose but don't gain!!! Also don't lose so much that your bmi goes below qualifying.

[justintime 9]

I was so excited when I was approved in one hour!