Submit to insurance Day 1 of coverage?

brownbeauty · February 27, 2008

I went through the Pre-op process with the surgeon that I would like to do my lap band surgery about 4 months ago. Back when I had United Health, the surgeon's practice was not IN Network so they did not submit to insurance. I have since changed coverage (my husband got a new job). March 1 we will have Blue Cross Blue Shield, who is contracted with my surgeon's practice. The insurance department has seen 100s of surgeries approved with Blue Cross Blue Shield. I am so very anxious to have the surgery done, I would like to submit the claim for the Lap Band March 1, the day coverage starts./ Do you think that is a good idea? I am pretty sure I will be approved, my BMI is 44. The policy states that obesity surgery isn't covered unless it is deemed to be "medically necessary" - which mine is, I am 28 with HBP and Morbidly OBESE.

Please advise as to what I should do. Do I wait it out or submit right away?:smile2:

Thanks!

Brown Beauty ♥

Elisabethsew · February 28, 2008

You're paying to be covered by this insurance company as of 3/1 so you're entitled to benefits. I would call them and ask for a written list of what they require to pay for the surgery. It's better to know before hand so you can check them off as they get done. Welcome and congratulations!

Thin4Anisha · February 28, 2008

I will be doing the same thing. I (for various reasons) did not sign up with my companies health insurance during open enrollment. Now that I have decided to have the band I find out my other insurance, through my parents, does not cover the procedure but the insurance my company offered does. I will sign up with the company during this years open enrollment and on 1/1/09 I will submit the paperwork.

Good luck to you and please keep us posted on the companies response!

NicoleW8ing · February 28, 2008

I went through the Pre-op process with the surgeon that I would like to do my lap band surgery about 4 months ago. Back when I had United Health, the surgeon's practice was not IN Network so they did not submit to insurance. I have since changed coverage (my husband got a new job). March 1 we will have Blue Cross Blue Shield, who is contracted with my surgeon's practice. The insurance department has seen 100s of surgeries approved with Blue Cross Blue Shield. I am so very anxious to have the surgery done, I would like to submit the claim for the Lap Band March 1, the day coverage starts./ Do you think that is a good idea? I am pretty sure I will be approved, my BMI is 44. The policy states that obesity surgery isn't covered unless it is deemed to be "medically necessary" - which mine is, I am 28 with HBP and Morbidly OBESE.
Please advise as to what I should do. Do I wait it out or submit right away?:thumbup:

Thanks!

Brown Beauty ♥

Check on Blue Cross's requirements in your states for pre-op. If you don't have all the i's dotted and t's crossed, they'll deny you. Just go over it thoroughly and make sure you have everything, and I don't see why you shouldn't submit it on Day 1.

For me, BCBS required a 5 year CONSECUTIVE weight history.