Starting program, confused!

[haleymarie 35]

So I just got approved to start the bariatric program through the Cleveland clinic. So far I've completed the seminar, and spoken with my patient navigator, and scheduled all my appointments needed. I'm really excited besides the fact I'm completely lost at how this works! The navigator told me I had to set up a bariatric resource nurse through my insurance and the insurance is saying they don't offer that and it's a cycle of back and forth at this point. I'm also confused at how payment will work and all the little details of how the program works! So far they've handled everything over the phone, is it okay to ask to meet her in person and go over all the insurance and payment information with her?

[2goldengirl 2,076]

If your insurance doesn't offer a case manager or resource nurse, they don't. period. Ask to speak to the Navigator's manager if you continue to have trouble. Your Navigator may or may not be able to meet with you in person, it depends on whether the Clinic allows that in her/his job description.

As far as the insurance information goes, call your insurance company. Ask about your benefits for bariatric surgery. They will be able to tell you what your copay/deductible is, and how far you've gotten toward meeting any out-of-pocket maximum for the year. You will probably be look up your insurance company requirements online: Google "nameofhealthplan state medical policy bariatric surgery". I lot of plans do have their policies online.

The Clinic will have an insurance coordinator who works on getting your health to approve your surgery. Probably you won't talk with whoever that is, that's why you have your Navigator. You can ask what the options are for payment of your out-of-pocket portion and any financing options they offer.

How it works: once the Clinic verifies your benefit and gets an estimate on your out-of-pocket expenses, they will let you know. That's why you want to check on this on your own, so whatever numbers you get from them make sense to you. As you get your other appointments taken care of, you will either pay copays for them up-front or get bills for them after your insurance has paid their portion, depending on the type of insurance you have. The actual surgery involves charges from the , any assistant surgeon, anesthesiologist, pathologist if there is any testing done on tissue they remove, and the hospital itself. All of them will bill your insurance first. Most of the time, they bill you at the same time they bill your insurance. Don't pay anything until you get a bill that actually shows what the insurance has paid. sometimes it takes a billing cycle or two before the insurance payments are reflected.

You're getting information thrown at you all at once, and it can be really overwhelming. Just keep answering questions, taking notes, and asking more questions. It will all be OK!

[pammyg7 10]

I went to True results and they took care of every detail!! My insurance covered but the copay was around $3900.00 and True Results financed that portion with not interest!! I had my surgery yesterday and I am looking forward to the end results!