Question:
My insurance policy lists

BUT...there are no bariatric surgeons in their plan. Any idea how I can go about getting them to approve an out-of-plan surgeon or treatment center?    — Julie K. (posted on August 18, 1999)


August 18, 1999
i too had the same problem the "only surgeon there was" or so i thought was an out of insurance network, and my insurance wouldn't cover it. look in the telephone book under surgeries and try to find gastric surgeries, not weight loss or gastric weight loss surgeries but common surgeries (mine was under laprascopic advanced surgies) it may take some time but as the saying goes let your fingers do the walking. hope this helps. good luck with everything. deb p.s. my dr.s real practice is trauma surgery.GO FIGURE!!!
   — deborah H.

August 18, 1999
I had an insurance that said the same thing. Beings no one did the surgery "in system" I was able to go out of system with an approval from my family Dr. I had my surgery in the Detroit area, with my Dr. being located in Jackson.His name is Dr. Sapala his phone # is 1-800-290-6565. The office people work with the insurances so it's not all up to you.They are really good.You can go for a free consultation, but try to call them first and they'll tell you what you need. I had to get a refferal which my family Dr. endorsed and after that I only had my yearly deductible that I had to pay. Dr. Sapalas office should be able to tell you better than I can. I had my surgery last April of 98 and I have lost 159#. I had asthma High blood pressure,water retention, no energy etc. and I weighed 342#. My life is so different now. If you want to know more feel free to write me back. I could even meet with you, I have a brother that lives in Monroe and a daughter that lives in Woodhaven,(MI) Let me know what you decide. Dr. Sapala is GREAT!!If you get a chance, read my profile, it's all in there. Good Luck, and God Bless!! Jan Terry
   — Jan T.

August 18, 1999
I to had insurance to cover my surgery but that kind of surgery is a specialty. All you need to do is find the surgeon and contact the insurance company and ask them to pay in network and they will but you must ask and it takes a little time but it is worth it. Good Luck from [email protected]
   — Patricia B.

August 27, 1999
Hi Julie, My insurance co. (Health Partners) also says this surgery is covered. After wasting 1 week taking the steps they told me I had to take, I am now starting over doing it a different way (I suppose next week they will tell me a 3rd way to handle things). Anyway, apparently my primary Dr. has to write a letter for pre certification for the surgery. Then IF the insurance co. denies the surgery, then the surgeon is suppose to write a letter to the insurance co. Supposedly I have to meet certian criteria for the surgery, but when I ask what that is, they won't tell me. I should have know last week that I was going to be given the run around. I will hang in there and I hope you do the same. Write down names, dates, and a summary of every conversation you have.
   — Jan B.




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