Insurance Letter

[lauriev 71]

I got a letter from the insurance company today and not quite sure how to interpret it.

It says:

Based on the documentation submitted, 43775 for a laparoscopy sleeve gastrectomy is covered under the member's plan.

However, predetermination of benefits does not guarantee payment. Benefits are always subject to other applicable requirements such as preexisting conditions, limitations and exclusions, payment of premium and eligibility at the time of care and services that are provided, and participating and/or network provider status. also, note that some services require predertification

not quite sure if this is approved or not and the doctors office is closed for the day - help????

[2goldengirl 2,076]

It confirms that you have the benefit for bariatric surgery, but there has been no decision made on approval or denial of any surgery (possibly because no request has been submitted yet). It also means you have to be eligible with your plan at the time you have any services (standard disclaimer).

I hope this helps!

[lauriev 71]

ok, so I called the insurance company and the lady told me I AM APPROVED!!!! she said the other verbiage is just to say that if I am no longer employed or my insurance is no longer active at the time of surgery then it is not covered. Then she sent me an email with several videos on sleeve surgery, anesthesia and recovery

My next task is my ultra sound and my endoscopy - so super excited!!!

[perforce 243]

Congratulations, I'm glad it didn't turn out to be something bad.