Insurance Confusion

[Jill8008 6]

At what point in the process is your health insurance provider contacted by the surgeon’s office in regards to verifying what pre-op requirements the insurance has?

I have had my initial consult with surgeon, an EGD, my sleep study is scheduled. When I spoke to my insurance (United Health Care) on 3 separate occasions to verify and re-verify their requirements, the reps I spoke to honestly did not sound very knowledgeable, which is not very reassuring. One told me that there was no requirement for a 6 month diet, one told me there was, one said they could not find any information. Am I speaking to the wrong people? Should I be requesting to speak to a certain department?

Not one person from UHC mentioned anything about a requirement to see a Nutritionist, but the nurse from my surgeon’s office sent me an email with a list of pre-op tests and says that a 3 month visits with NUT is an insurance requirement.

I am soooooooooooo confused about the insurance requirements and I’m far from being a dumb person.

[moondoggie1983 202]

At what point in the process is your health insurance provider contacted by the surgeon’s office in regards to verifying what pre-op requirements the insurance has?
I have had my initial consult with surgeon, an EGD, my sleep study is scheduled. When I spoke to my insurance (United Health Care) on 3 separate occasions to verify and re-verify their requirements, the reps I spoke to honestly did not sound very knowledgeable, which is not very reassuring. One told me that there was no requirement for a 6 month diet, one told me there was, one said they could not find any information. Am I speaking to the wrong people? Should I be requesting to speak to a certain department?
Not one person from UHC mentioned anything about a requirement to see a Nutritionist, but the nurse from my surgeon’s office sent me an email with a list of pre-op tests and says that a 3 month visits with NUT is an insurance requirement.

I am soooooooooooo confused about the insurance requirements and I’m far from being a dumb person.

The best thing to do is go to your health insurance provider’s website and email them requesting a copy of your plan’s requirements for an approval for WLS. They should email you a copy within a couple days.
But odds are good that if your doctor is telling you it’s required, it’s required. I’ve worked in medical for a LONG time. If your a specialty medical provider, you’re going to be incredibly familiar with the requirements for every health plan you accept at your office.
I never trust a basic representative from a customer service line when it comes to healthcare. They usually have no idea when it comes to anything other than regular pcp and rx care. Anything with a specialization and they tend to not know.


HW: 311
CW: 258
SW: We’ll see on May 10!
First goal weight: 191 lbs
Second goal weight: 159 lbs
Goal weight: 142 lbs

5’6” 34 yo female in NC

[moondoggie1983 202]

At what point in the process is your health insurance provider contacted by the surgeon’s office in regards to verifying what pre-op requirements the insurance has?
I have had my initial consult with surgeon, an EGD, my sleep study is scheduled. When I spoke to my insurance (United Health Care) on 3 separate occasions to verify and re-verify their requirements, the reps I spoke to honestly did not sound very knowledgeable, which is not very reassuring. One told me that there was no requirement for a 6 month diet, one told me there was, one said they could not find any information. Am I speaking to the wrong people? Should I be requesting to speak to a certain department?
Not one person from UHC mentioned anything about a requirement to see a Nutritionist, but the nurse from my surgeon’s office sent me an email with a list of pre-op tests and says that a 3 month visits with NUT is an insurance requirement.

I am soooooooooooo confused about the insurance requirements and I’m far from being a dumb person.

Also, you’re NOT dumb. Insurance is on a whole different planet.


HW: 311
CW: 258
SW: We’ll see on May 10!
First goal weight: 191 lbs
Second goal weight: 159 lbs
Goal weight: 142 lbs

5’6” 34 yo female in NC

[Yo-yo girl 118]

If the center for Weightloss you are being treated at takes your insurance then the team working with you knows exactly what they require and will not make you go through any hoop you don’t need to go though. 9 out of 10 times they already had patients with that same insurance and they are not new to this, just trust the process. Besides the people who speak to patients and speak to office from the doctors are completely different.


Yo-Yo Girl from New York City

[Frustr8 7,886]

Different prioritie, different plans, devoted to charge high, pay out low or not all. That mi amiga, is the current American Insurance system, anybody else wish for universal insurance and healthcare? My Canadian, Australian and British cousins say theirs aren't always perfect But,in has got to better than ours with the clunky square wooded wheels!😋

[Jill8008 6]

Thanks for some voices of reason and for reminding me that they most certainly have dealt with my insurance before and know what we are working with.

But I will definitely message them asking for that specific document. I had no idea that existed for the consumer side.

[moondoggie1983 202]

Thanks for some voices of reason and for reminding me that they most certainly have dealt with my insurance before and know what we are working with.

But I will definitely message them asking for that specific document. I had no idea that existed for the consumer side.

It does. I knew what they required, but by god I was going to make sure. So I sent that email and 24 hours later I had a response and 30 odd pages regarding every aspect of the surgery. When I got approved a week ago, BCBS actually sent me a nice letter in the mail telling me congratulations on making the difficult decision to become healthier, all the benefits WLS provides and a good luck to a healthier new me.



HW: 311
CW: 258
SW: We’ll see on May 10!
First goal weight: 191 lbs
Second goal weight: 159 lbs
Goal weight: 142 lbs

5’6” 34 yo female in NC

[ByeFelicia 22]

58 minutes ago, Jill8008 said:

At what point in the process is your health insurance provider contacted by the surgeon’s office in regards to verifying what pre-op requirements the insurance has?

I have had my initial consult with surgeon, an EGD, my sleep study is scheduled. When I spoke to my insurance (United Health Care) on 3 separate occasions to verify and re-verify their requirements, the reps I spoke to honestly did not sound very knowledgeable, which is not very reassuring. One told me that there was no requirement for a 6 month diet, one told me there was, one said they could not find any information. Am I speaking to the wrong people? Should I be requesting to speak to a certain department?

Not one person from UHC mentioned anything about a requirement to see a Nutritionist, but the nurse from my surgeon’s office sent me an email with a list of pre-op tests and says that a 3 month visits with NUT is an insurance requirement.

I am soooooooooooo confused about the insurance requirements and I’m far from being a dumb person.

Thankfully, my insurance company had the requirements listed in their benefits handbook. But the surgeon's office had a list of the difference insurance companies and their requirements, so the scheduler knew exactly what my insurance required and she said they usually added extra items the insurance didn't ask for. Also, because the hospital I'm using is a Bariatric Center of Excellence also helped as far as insurance approval went.

I'm pretty sure that the surgeon's office knows what they're doing since they should specifically have someone that does nothing but deal with insurance companies. Hopefully everything goes smoothly for you!

[Jill8008 6]

18 minutes ago, ByeFelicia said:

Thankfully, my insurance company had the requirements listed in their benefits handbook. But the surgeon's office had a list of the difference insurance companies and their requirements, so the scheduler knew exactly what my insurance required and she said they usually added extra items the insurance didn't ask for. Also, because the hospital I'm using is a Bariatric Center of Excellence also helped as far as insurance approval went.

I'm pretty sure that the surgeon's office knows what they're doing since they should specifically have someone that does nothing but deal with insurance companies. Hopefully everything goes smoothly for you!

Yes my hospital is also a COE. I know they’re covering their bases an experienced at getting people approved, but I am paranoid that I’m going to get to the “finish line” and insurance is going to come back with some off-the-wall requirement that hadn’t been thought of. I feel bad for the person who has to deal with insurance all day, it must be a headache. I’ll need to remember to get him/her a thank you gift!

[ByeFelicia 22]

12 minutes ago, Jill8008 said:

Yes my hospital is also a COE. I know they’re covering their bases an experienced at getting people approved, but I am paranoid that I’m going to get to the “finish line” and insurance is going to come back with some off-the-wall requirement that hadn’t been thought of. I feel bad for the person who has to deal with insurance all day, it must be a Headache. I’ll need to remember to get him/her a thank you gift!

COE's know how and what to do to help get you approved. Your fear is valid and legit, because everyone who is going through and has been through the process has the same fear. But just think of how worth it, it will all be.

I feel bad for the person dealing with insurance too!! Mine was so sweet, that I sent her an edible arrangement because while you're waiting for approval and a surgery date you'll feel like you are bugging that person non-stop; but I think they're so used to it that it doesn't really phase them. Good luck!!