Surgery covered but EGD not??

[cellbell 113]

This is so frustrating! I've been jumping through hoops since last SEPTEMBER to get all my appointments scheduled, and I'm almost at the last step: the EGD, after which my doctor will schedule my RnY. I just learned that neither of my insurance companies consider the EGD to be medically necessary. I'm double-covered with my husband's insurance because it's free at his work as long as it's secondary coverage, and my own insurance specifically excludes bariatrics. The actual RnY has been pre-approved through my secondary coverage.

Both companies are different branches of Blue Cross, so maybe that's the issue? I'm really annoyed because it's a HDHP, so my out of pocket was already going to be substantial, and paying cash for the EGD means I could have done self-pay elsewhere months ago!

Anyone else have trouble getting the EGD approved? My doctor said that this is becoming a common way for insurance companies to avoid some of the costs associated with bariatric surgery.

Edited June 24, 2021 by cellbell

[lizonaplane 1,613]

That's so frustrating! Insurance in this country is such a nightmare, but I've heard that in other countries, WLS isn't often covered by national insurance at all. I don't have to have EGD, so I don't know if my insurance would cover it. So far, I've just had a lot of $50 copays for all the specialist visits (I have a lower deductible but it will only apply to the surgery itself. My plan is weird for the deductible.). I also have BCBS, but it's a PPO. Good luck with your surgery!