Pre-op Program/Insurance Approval Process?

[juliansmom2003 3]

I am so excited after attending the Lap Band seminar last week -- my first official step!! The surgeon mentioned not to get discouraged because it could take a few weeks before being able to get an appointment, but I got REALLY lucky when calling yesterday. They had a cancellation for THIS Friday morning, so I snatched that appointment right up :-)!

The next step after going to this consult is to contact New Beginnings (their pre-op program) to make my initial consultation with them.

I was wondering--does anyone know when a surgery date would be assigned or when the insurance approval process begins? I know everyone is different and I plan on asking at my appointment from Friday, but I'm just trying to at least get a sense for how it works. I have to pay $1,450 out of pocket for the pre-op program, which my insurance doesn't cover, so I'm hoping they don't wait for me to go through that first to then get declined from my insurance company because I simply cannot afford to pay out of pocket for the procedure. I have Keystone Health Plan East (Blue Cross Blue Shield)-PPO Plan. Does anyone have any insight into this?

[HolliJ 24]

From what I've seen, it really depends on your insurance policy. Everyone has different requirements. The surgeon's office typically calls them and finds out what benefits you have. Some people have to do a 6-month physician-assisted diet. So that slows things down.

Sometimes it depends on your surgeon, how long it takes to get the paperwork, etc...

For me... I had my seminar on 5/28. My consult was on 6/15. All my other appointments fell between 6/22 and 6/30. They're supposed to be submitting my insurance paperwork like... today-ish. And I have my surgery scheduled (tentatively, until insurance is approved) for July 28.

So if everything goes as planned, my time from seminar to surgery will be exactly 2 months.

[juliansmom2003 3]

Oh yes, my insurance requires the three-month supervised program (the New Beginnings that the surgeon makes us do). That is the actual requirement, so I'm thinking that after I complete that, then they submit everything for approval? My thing is that I don't want to fork over that much money if they aren't going to approve it, but I guess as long as I go through the program, why would they deny me? LOL, I think I may have just answered my own question.

Thanks for responding!

[HolliJ 24]

Exactly. I don't think they'd deny you if you meet all the requirements and go through the three-month diet.

You'll be ok

[RestlessMonkey 7]

WOW I honestly would NOT pay almost 1500 in "fees"...I truly think that is just an end run around insurance. Is there no other facility you can use?

"New Beginnings" is a franchise, I think...but there should be some reputable bariatric surgeons in your area and on your insurance that don't charge a fee apart from insurance. In some cases that is actually illegal.

Just something to consider; I don't know about you but I'd hate to pay almost 1500 for something that should've been covered by my insurance.

[HolliJ 24]

I agree with Restless. I know many surgeons charge program fees, which I think is ridiculous. The surgeon I was originally looking into had a $3,700 program fee. I said, "Forget it!". I'm so happy, because my current surgeon is such a wonderful person! And the best part is that he has ZERO program or administrative fees.

[kairos 0]

I have bluecross/blueshield in Texas. They required a five year history of a bmi of 40 or higher, and a six month physician supervised program. I joined weightwatchers online for $30 a month and started their program including the weekly meetings. I also scheduled a monthly appointment with my family doctor specifically to discuss the diet effort. Total cost: $180 for weight watchers and about $175 for office visit co-pays.

Southwest Bariatric submitted my claim for approval on July 1st and I was informed today that I had been approved.