Seeing Doctor Before Approval?

[Deleted Account 151]

This is my first post, and I would truly appreciate any and all replies.

I am confused about seeing my doctor before knowing that I'm approved. I have Medicare (not Medicare Advantage) with Blue Cross/Blue Shield being my secondary.

A few weeks ago I sent in all my paperwork including insurance information to my surgeon. Tomorrow I have an appointment with him. To my knowledge I have not yet been approved by my insurance to have surgery.

So my question is, is this normal? Do you see your surgeon and go through all the hoops before ever being approved? I guess it's just not making sense to me.

Thank you so much!

[AsianBeauty 78]

Hello and welcome. I have Anthem BCBS. I had a coordinator that I worked with through Ohio State University Bariatric program. She made sure and helped me complete everything I needed for my insurance to approved me. When everything was completed she submitted it to my insurance. I waited for approval then I had an appointment to meet with my surgeon. That's when I received my surgery date. From what I'm hearing all surgeon are different. So I would say just go with the flow of how they are doing things. Maybe they kno w from experience that your insurance is easy approved so there not to worried. Or maybe surgery dates are backed up and they want to m ake sure they have you scheduled. It could be a lot of different reasons. What I've learned is ask a lot of questions. There are no stupid question.

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[Deleted Account 151]

Thank you, AsianBeauty. Great advice! I'll know more tomorrow (Ihope). This is all a bit overwhelming. 😀

[mybariatricjourney 24]

If I'm not mistaken, you only see your surgeon prior to your procedure to finalize and sign paperwork and that's normally done once approved!!!! I'm getting sleeved on 8-21 next Monday. My paperwork was submitted to my insurance (Fidelis) on last Friday and approved on Tuesday and my appointment to see my surgeon is 8-17!

mybariatricjourney

[Deleted Account 151]

Thank you so much! I'm sure hoping that's the case. Congrats on being approved! That's wonderful!

[Miss Topaz 300]

I have Anthem BCBS as well. I had to meet with the surgeon after a wls information seminar to determine which surgery I was interested in and if I was a good candidate. Since then I've seen my primary care, a dietician and psychologist. I don't expect to see my surgeon again until my surgery pre-op appointment after scheduling, but my initial appointment was with him.

[Deleted Account 151]

38 minutes ago, Miss Topaz said:

I have Anthem BCBS as well. I had to meet with the surgeon after a wls information seminar to determine which surgery I was interested in and if I was a good candidate. Since then I've seen my primary care, a dietician and psychologist. I don't expect to see my surgeon again until my surgery pre-op appointment after scheduling, but my initial appointment was with him.

I think this is what's confusing to me. Do people have all this work up done, and then sometimes be not approved? I'm guessing that all of this costs money, so does one pay beforehand? Nothing has been said about any money yet, but it would be nice to know before I go tomorrow.

[AsianBeauty 78]

When you meet with your coordinator through the Bariatric program / hospital that you're going through they will tell you everything you have to do that your insurance requires for you to do for them to approve you. So it comes down to if you are using insurance to pay for the surgery or are you a self payer. If you are using insurance then you won't know if you're approved until you go through all of there hoops and hurtle. From my insurance to approve me I either have to have a BMI of at least 40 or a BMI of at least 35 with 2 cormobilities like diabetes and high blood pressure. Then I had to complete the 6 months of weight management with my PCP. So you basically know if your insurance will approve you. My first attempt turning in my paperwork to my insurance I was denied and that was because my 6 months was not a consecutive 6 months so they made me do another weight management with my PCP. After that I was approved. Now I have a deductible that I have to meet before I can have surgery. Now that I'm approved I will have to pay my deductible. Because I've had other things happen through out the year my deductible has already been meet so now my surgery is paid 100%. If you're self pay I believe you just have to be paid in full before surgery. There should be options to do payment plans. I hope at least some of this help with the confusion.

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[NewEnglander 5]

It's different for everyone. It is a bit overwhelming...do this, do that , go here go there! In the end it will all work out and your surgery will be done. Then you'll continue to go here and there and do this and do that...but you'll be getting much healthier, wearing smaller clothes and probably feeling better about yourself.xo you got this!!!

[Miss Topaz 300]

2 hours ago, Elise24 said:

I think this is what's confusing to me. Do people have all this work up done, and then sometimes be not approved? I'm guessing that all of this costs money, so does one pay beforehand? Nothing has been said about any money yet, but it would be nice to know before I go tomorrow.

I haven't paid anything for any of my visits yet. I think my insurance is covering. But, like NewEnglander says, it's different fore everyone. Depends on your insurance, your provider, etc.

[AsianBeauty 78]

When you meet with your coordinator through the Bariatric program / hospital that you're going through they will tell you everything you have to do that your insurance requires for you to do for them to approve you. So it comes down to if you are using insurance to pay for the surgery or are you a self payer. If you are using insurance then you won't know if you're approved until you go through all of there hoops and hurtle. From my insurance to approve me I either have to have a BMI of at least 40 or a BMI of at least 35 with 2 cormobilities like diabetes and high blood pressure. Then I had to complete the 6 months of weight management with my PCP. So you basically know if your insurance will approve you. My first attempt turning in my paperwork to my insurance I was denied and that was because my 6 months was not a consecutive 6 months so they made me do another weight management with my PCP. After that I was approved. Now I have a deductible that I have to meet before I can have surgery. Now that I'm approved I will have to pay my deductible. Because I've had other things happen through out the year my deductible has already been meet so now my surgery is paid 100%. If you're self pay I believe you just have to be paid in full before surgery. There should be options to do payment plans. I hope at least some of this help with the confusion.

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Oh and also I had just my regular copays for my office visits. I believe if you are self pay then there is a set price and that covers everything.

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[Deleted Account 151]

35 minutes ago, AsianBeauty said:

When you meet with your coordinator through the Bariatric program / hospital that you're going through they will tell you everything you have to do that your insurance requires for you to do for them to approve you. So it comes down to if you are using insurance to pay for the surgery or are you a self payer. If you are using insurance then you won't know if you're approved until you go through all of there hoops and hurtle. From my insurance to approve me I either have to have a BMI of at least 40 or a BMI of at least 35 with 2 cormobilities like diabetes and high blood pressure. Then I had to complete the 6 months of weight management with my PCP. So you basically know if your insurance will approve you. My first attempt turning in my paperwork to my insurance I was denied and that was because my 6 months was not a consecutive 6 months so they made me do another weight management with my PCP. After that I was approved. Now I have a deductible that I have to meet before I can have surgery. Now that I'm approved I will have to pay my deductible. Because I've had other things happen through out the year my deductible has already been meet so now my surgery is paid 100%. If you're self pay I believe you just have to be paid in full before surgery. There should be options to do payment plans. I hope at least some of this help with the confusion.

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It helps a lot!! Thank you so much!

[belinda401 116]

On 8/13/2017 at 10:55 AM, AsianBeauty said:

Hello and welcome. I have Anthem BCBS. I had a coordinator that I worked with through Ohio State University Bariatric program. She made sure and helped me complete everything I needed for my insurance to approved me. When everything was completed she submitted it to my insurance. I waited for approval then I had an appointment to meet with my surgeon. That's when I received my surgery date. From what I'm hearing all surgeon are different. So I would say just go with the flow of how they are doing things. Maybe they kno w from experience that your insurance is easy approved so there not to worried. Or maybe surgery dates are backed up and they want to m ake sure they have you scheduled. It could be a lot of different reasons. What I've learned is ask a lot of questions. There are no stupid question.

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How long did it take you to get an approval from anthem once your paperwork was submitted?

[AsianBeauty 78]

How long did it take you to get an approval from anthem once your paperwork was submitted?

I was approved the same day. Mine was supper quick.

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[Shawn75 2]

I have Anthem BCBS as well. I had to meet with the surgeon after a wls information seminar to determine which surgery I was interested in and if I was a good candidate. Since then I've seen my primary care, a dietician and psychologist. I don't expect to see my surgeon again until my surgery pre-op appointment after scheduling, but my initial appointment was with him.

This is the same exact process I have gone through. And I will see him again for a pre-op before surgery.

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