Question:
What is the process of getting your insurance company to cover bariatric surgery?
I called my ins. co. and they say "no, we don't cover that" but from this website I see that BCBS of KS HAS covered others before and I don't really know where to go from here? Do i need to get proof from my doctor that I need this surgery for health reasons or do I need my insurance company to tell me first that IF i can get proof from my doctor that they would approve me? HELP! — Lcky4me (posted on January 17, 2007)
January 17, 2007
I would work at both at same time. Enlist your Dr to help you get started
on a Dr supervised weight loss program. I did weight watchers and checked
in with him every month for weight evaluation. Make sure you do not miss a
month. Some insurances are very very picky about that!
As for your insurance company arm yourself with the information from
website and call again. If the initial person says no that weight loss is
not covered ask to speak to his superior and continue on up the line till
you get someone who knows.
I have been told for years by the first phone line of Insurance defense
that no weight loss surgery or assistance was available. They authorized
it first time around when I finally started the process.
Good luck!
CarolynK
— CarolynK
January 17, 2007
The insurance company assumes that if they say no, you will accept that
answer. Don't give up. Talk to your pcp, have them set you up with a GI
program at a local hospital. Have your pcp write a letter to the insurance
company telling them of all your health problems and risks. Hopefully, they
will decide that is is cheaper for them in the long run to pay for the
surgery rather than all your health problems down the road. Good luck to
you!
— jlw0423
January 17, 2007
I would first select a surgeon that has a knowledgable staff and knows the
how to get the patient approved quickly. I have never seen so many people
that are forced or think that the burden falls soley on them. Most
insurance companies will deny "bariatric" surgery. Thats's why
medical diagnosis is required with the obesity dx and so many requirements
have to be met prior to surgery. The best thing to do is go with a facility
that specifically handles obesity surgery or a surgeon that doesnt do any
other services but gastric bypass or lap band. These type of dr's (such as
innova or nuweigh) specialize in this type of surgery and definitely know
how to get the insurance to pay. its the only service that they provide so
of course they want to get pd.
— _blue_
January 17, 2007
Everyone is different, so I will tell you how I got approved. I first had a
consultation with the RNY doctor who gave a list of all the thing I need it
to send to the insurance. They were, medical necessesity from my PCP,
nutritional consultation, Pulmonay consultation, sleep apnea test, and
psychological evaluation. Once I had all this, his office sent the
information to the insurance and I was approved in 3 days. Make sure the
doctor's office is knowledgeable about what each insurance wants. Talk to
your doctor, he's the best person to guide. Remember, each case is
differente. Good Luck !!!!!!
— Beatriz A.
January 18, 2007
Step 1: Look on your insurance's website for their clinical guidelines for
bariatric surgery. Most will not cover it as elective surgery, but will
cover it if you have a certain number BMI and comorbidities such as heart
disease, diabetes, or sleep apnea.
2. Go to your doctor and begin a doctor-supervised diet. Get weighted in
at least once a month at the docotr and make sure the doc documents your
efforts.
3. When you begin your weight loss diet, also go to the surgeon and get a
surgery date set for seven months after you begin your diet. You can
always cancel if you need to.
The trick is to have everything going at once, so that, when you finish
your requirements, you will already be set for your surgery.
Good luck!
— Novashannon
January 18, 2007
Your doctor should be the one getting approvals for you. I agree with the
other posts.
— Sheri A.
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