Should I contact the doctor or Ins first?

[Iwanttodoit 0]

I want to do it ( banding that is) and I'm not sure if I should see doctor first or go straight to the ins co for approval. Can the doctor help me with the approval process? What should be my first move to having ins pay?

[bmysuccess 0]

go to the Dr, they have people trained on working with the ins. company. Good luck

[Ellisa 6]

Usually the doctor will have you check with your insurance first to be sure there are no exclusions on your policy for bariatric surgery.

[faithmd 14]

Absolutely NOT THE DOCTOR. Get your insurance card out and call them now, right now, today. it will take a few mintues and then you will know:

A) if it's even a covered benefit for your plan

WHO they will pay for you to go see.

C) how much of a deductible or co-pay you'll have

D) what the requirements are to have it covered (some require a three, six or even twlve month diet/exercise visit history with your doctor. In some cases, only office notes will do, letters won't cut it. Some require a BMI or 40, or 35 with co-morbidities. Some require over 100lbs over weight for a certain number of years. Some require a BMI greater than a certain number for X years.

See why it is soooooo important to call your insurance company FIRST?

Good luck!!

[candy8360 0]

I went to an informational seminar first, then called my insurance and found out what was needed. Part of what I needed was a recent physical, so then I went to my doctor.

[faithmd 14]

The doc's office does have people who will navigate the insurance obstacle course, but first you have to know if they'll even pay (some plans have it as an exclusion-you won't know until you call with YOUR card to your ins company). What if they won't pay for you to see the doctor who's info session you went to and who you are now comfortable with? That happened to me.

Exclusions are all too common. You and I may have the same insurance, but if we are at different employers, one may have chosen not to pick up the bariatric surgery rider, so while you may have the rider that allows WLS, I may not and it may be a total exclusion for me.

[Wheetsin 714]

Yah I disagree with first advisor. Talk to INSURANCE first. You don't want to get your hopes up (if self pay isn't an option), nor do you want to run the risk of getting billed for anything from the surgeon.

[kaninag 35]

yeah def call the insurance company first bc they can tell if theyll pay for it, how much they'll pay and EXACTLY what they're requirements are before you can have the surgery. That way you can start your journey bc it may be awhile before you even need to see the surgery...ie: you need your 6month weight loss program. Good luck

[4jin 0]

Yep I say the same insurance first!

I called my insurance first and they covered is what I was told under my primary insurance for all bariatric fda approved treatments and surgical procedures/follow-ups..and surprisingly my secondary does not!

then I scheduled the informational seminar. At the info seminar they gave me specific questions to call back the insurance co about. Which the doctor office calls but they want to make sure you have done some homework and made sure it is not excluded from your insurance policy.

Like the doctor's office wanted to know co-pay amnts, deductible amounts and what percentage is covered.

If you go and schedule the info seminar you and your insurance excludes bariatric surgery you waisted your time and theirs and took a spot someone else could have taken unless you can right then and there say you have funds for self-pay..