Help

[mspatches320 1]

Do i need to go to my primary care physician first or can i go to the Bariatic Clinic and start my journey ?

IThank you

[2goldengirl 2,076]

That depends on two things. First, what your insurance requires. Second, does the clinic require a referral from your PCP? You can call the clinic and ask, and tell them what insurance you have. Thoey will probably know what yoru insurance requires. They will definitely know whether you need a referral from your PCP first.

Good luck.

[Inner Surfer Girl 12,015]

If you are in the U.S., I believe you can start either way. I started with my PCP and fortunately, he referred me to an outstanding program/surgeon.

If you start with the surgeon, they can help you determine whether or not your insurance requires a referral from your PCP.

Whichever way you go, I highly recommend you use a program that is a Bariatric Center of Excellence. They will be able to help you navigate the whole process.

Best of luck with your journey. It's quite an adventure.

[BeagleLover 1,020]

I suggest calling your insurance company before you see anyone to see if they require that the surgery be done at a Bariatric Center of Excellence.

[mspatches320 1]

I have Anthem Blue Cross Blue Shield. I contacted them today and they sent me this

Bariatric/gastric bypass surgery is covered if deemed medically necessary. You or your provider can view our medical necessity guidelines for this kind of surgery at the following web address:

http://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm

Pre-certification is required. Your provider may call 1-800-690-0512 to request an authorization.

Your plan provides coverage for surgery based on medical necessity. Surgery that is considered cosmetic, investigational or experimental will not be covered. Referrals are not required.

In-network coverage is at 100% of the maximum allowed amount, with no co-payment or deductible. In-network providers are required to accept the maximum allowed amount for services covered by your policy. If services are rendered inpatient, the facility will charge a $300 admission co-payment.

Out-of-network coverage is at 70% of the maximum allowed amount, subject to the out-of-network deductible of $750 per person or $2000 for the family. Please be advised that an out-of-network provider can bill you for any difference between the maximum allowed amount and the actual billed amount.

Anesthesia rendered by an out-of-network provider at an in-network facility will be covered at the in-network benefit level based on the provider’s total charge.

The out-of-network out-of-pocket maximum is $2500 per person or $7500 for the family. These totals include the coinsurance, but not any charges over the maximum allowed amount, penalties for non-compliance, deductible, co-payments, or non-covered services.

Using an in-network provider gives you a higher level of coverage. When using an in-network provider, please verify with the provider, at the time of service, that they are still contracted as PPO participating. This will ensure you receive the in-network level of benefits for your date of service.

Your deductible and out-of-pocket maximum can be viewed on our website. Please click the “Claims” tab at the top of the page. Now click the “Deductibles & Out of Pocket Amounts” tab. This will display the accumulations for your current benefit year. To view previous benefit year accumulations simply change the date range in the coverage period box on this screen.

[mspatches320 1]

I read on it some more and i would have to go to a Bariatric Center of Excellence. Wonder if i could just contact them ? They would be able to help me correct ?

[BLERDgirl 6,417]

I started with calling the program. I knew my insurance would be accepted and I was certain I would be eligible based on my weight alone. I did need an insurance referral from my PCP, but that was just a simple email much the same as if I was going to the allergist or any other doctor. "I have an appointment to see _______. I need a referral." The program I went with requires you attend and informational seminar before they will even schedule you with the surgeon. The seminar route was a good way to go because it gives you a chance to see if this is the hospital/program that is best for you. I would recommend looking at more than one if possible and always seek a center of excellence. There can be differences in philosophies for each program as well as a how they handle post-op support that can mean the difference between success and frustration.

[BLERDgirl 6,417]

I read on it some more and i would have to go to a Bariatric Center of Excellence. Wonder if i could just contact them ? They would be able to help me correct ?

Are you North or South Jersey? Most major hospitals have the Bariatric Center of Excellence certification.

[IncredibleShrinkingMan 437]

I needed to attend a bariatric information seminar before I could get into see a surgeon and begin pre-op testing. Somewhere in those initial visits, they ask for a PCP referral for their own purposes, not insurance. But check with insurance to make sure you have the correct order. In any case, the PCP referral will come at some point and you will be covered.

[mspatches320 1]

I live in Northern NJ near NYC .

[mspatches320 1]

I went to 2 seminars and the last one i went to i made an appointment which i had to wait a month for. For them to tell me my ins doesn't cover it. That was a year or two ago. I guess my ins changed that is why i asked them before i started to ask any questions here.

[Inner Surfer Girl 12,015]

I read on it some more and i would have to go to a Bariatric Center of Excellence. Wonder if i could just contact them ? They would be able to help me correct ?

Yes, they should be able to tell you who is in-network and also a Bariatric Center of Excellence.

[newmebithebypass 713]

I called my insurance first and got my coverage and then I called around to find a center of excellence and I went with one closest to my house the had a seminar online that I watched and then took a short quiz