What do I need to do w/insurance

[bostonmama 135]

I just started a weight loss surgery program, am I'm wondering what I need to do to make sure insurance covers this?

I'm guessing I need to make sure that all of the pre op clearance appointments are with doctors in the network . Should I call insurance to make sure the tests these doctors are doing are covered?

It it enough to see that the surgery itself is covered in my policy? Or should I talk to someone about it. I know my surgeons office does some kinda of application as well. Do I need to get anything in writing?

Tia!

[Julie_vsg_053116 13]

I just started a weight loss surgery program, am I'm wondering what I need to do to make sure insurance covers this?

I'm guessing I need to make sure that all of the pre op clearance appointments are with doctors in the network . Should I call insurance to make sure the tests these doctors are doing are covered?

It it enough to see that the surgery itself is covered in my policy? Or should I talk to someone about it. I know my surgeons office does some kinda of application as well. Do I need to get anything in writing?

Tia!

The first thing you need to do is call your jnsurance !!!! You need to find out if they cover it and what they require in order to cover it . For instance Medicaid requires 6 months of Doctor visits stating your over weight , a psychology visit , a nutritionist visit (atleast that's what they required when I was going to do it with them ) . My insurance now required 3 nutritionist visits , 1 psych evaluation and that's it and I had to lose weight during these nutritional visits. Once I did all that my doctors office submitted it to my insurance and that's when they gave me clearance for my surgery . It is really important to talk to your insurance first . Because mine is blue cross blue shield and they required it to be in a specific hospital . And in regards to covering your pre op visits that also depends on your insurance I had a large out of pocket so I had to pay all my pre op visits cash but if you have a lower deductible or none at all then your jnsurance should cover the pre visits . So my biggest suggestion is to call your insurance and find out what they require If it's even an option .

Good luck ❤️❤️

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[bostonmama 135]

Thank you - I also have blue cross blue shield, mine is of MA/ ppo, I called this morning and they emailed me their policy on medical /surgical management of obesity . They said it is a lot of medical jargon so I'll need to go over it with my surgeon, but they did tell me if approved I'll have a $500 copay for admission. I don't see anything in the policy about meetings with nutritionists or being on a weight loss plan for a certain amount of months. Is it possible these things aren't required by my insurance ?

[Julie_vsg_053116 13]

Its posible but I think you should call again asking that specific question if there are any requirements because I know I had to ask so many times for them to get me the accurate information . It's better to be safe than sorry you get me ? But If they don't require anything that's great that means that it will take less time and 500 is also great !!! Gooood luck !

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[MissMac 163]

You might even ask for your insurance to assign you a case manager so that you will have the same person to talk to every time you call. I have BCBS Federal Employee, and they give me a case manager for anything major that I have done. They have done it for a knee replacement, a stroke, and my sleeve.

[Diana_in_Philly 1,426]

Double check to make sure your surgeon and the hospital are on the approved list. Some plans (I'm with Harvard Pilgrim, but not in New England) require you use a "Center of Excellence" of which they maintain a list. Keep dialing that 800 number til you get all the answers you need. You don't want to be surprised by a balance bill because the doc, anesthesiologist or hospital were out of network.

[Read2016 658]

Talk the insurance coordinator at the surgeon's office, get a copy of your policy and compare what they both say... Good luck

"We can't solve problems by using the same kind of thinking we used when we created them"

Einstein

[evelaine 17]

I also have BCBS and the had a specific form with all the requirement and all the things you have to do to qualify. Mine also had to be at a center of excellence.

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[LisaMergs 2,854]

Any surgeons office worth their salt pretty much know what each company requires as far as preop etc. They should know just by seeing that you have a large standard carrier. The only difference would be if your company expressly wrote out Bariatric surgery coverage.

[kembfly 15]

Thank you - I also have blue cross blue shield, mine is of MA/ ppo, I called this morning and they emailed me their policy on medical /surgical management of obesity . They said it is a lot of medical jargon so I'll need to go over it with my surgeon, but they did tell me if approved I'll have a $500 copay for admission. I don't see anything in the policy about meetings with nutritionists or being on a weight loss plan for a certain amount of months. Is it possible these things aren't required by my insurance ?

I have BCBS of CA ppo, my policy reads similar to yours. I have a $500 admission and $200 copay for the specialist. My first appointment is June 6 with the Doctor and nutritionist. Mine stated 3 months supervised Doctor visits, I didn't see anything about the nutritionist but I'm glad I'm seeing one! I guess I'll find out more on Monday. It could be doctors recommendations. I'll let you know how it went.

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[Sleeve it to Beaver 187]

Ask a lot of questions of your insurance. For example, mine required me to see a nutritionist but didn't pay for it. Ask not only about covering surgery bit your journey (tests, appts, programs) in getting there. Good luck!

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