Question:
Can you start the insurance process before you have your consult?
I can't get intoteh surgeon unitl April :( But I was wondering if I could get a head start on getting the surgery autorized by my insurance. Thanks for any help or insight you can provide. — KENDRA H. (posted on January 31, 2002)
January 31, 2002
You can do some investigation with your insurance to see if WLS is a
covered benefit, but the actual request for preauthorization must be
submitted by your surgeon with appropriate procedure and diagnoses codes.
— JoanneML
January 31, 2002
Yes you can. I called my insurance company and spoke with one
representative. She explained my coverage and gave me her name, so I could
ask for her when calling back. This will help tremendously. My
representative sped the process up for me. She handled everything. I was
approved in less than two weeks. I'll never forget Jacqueline at BC/BS of
Alabama. I hope this helps.
— Tammy W.
January 31, 2002
I called in late August and was given a consultation date of November. I
talked to the girls in the surgeon's office and wondered about getting
insurance approval while I waited for the consultation. (I was hoping for a
January surgery date, and if I had waited until after my consultation date,
I would never have gotten the date I needed). They sent me information
about what I needed to do and submitted my paperwork for approval in
October. I was approved in 3 days. I went to my consultation with approval
and was given a surgery date on the spot. Others at the group consult were
just beginning the insurance process. So, yes, by all means get approval
first if possible. It will speed up the process. Good luck. Shelley
— Shelley.
January 31, 2002
I needed a letter of approval BEFORE I could even come into the Doctors
office. They would hardly talk to me until I Faxed that Approval letter
over, then they were sweet as Pie, and Gave me everything I needed. I even
got a quick date for my surgery even though they were scheduling into
April(at that time it was August 5th). My Surgery was December 14th! I
explained that the company I work for has lost money for 4 straight
Quarters, and may not be a company by the time april rolled around, so they
got me the quickest date they could get. Awsome!
— sbinkerd1
January 31, 2002
I called my insurance company before my consultation just to ask if they
covered the surgery and to find out exactly what I would need to provide
for them. I do not have an HMO, so I did not need a referral to my
surgeon. My insurance company told me all I would need was a statement as
to why the surgery was medically necessary. I contacted my family doctor
and he gladly gave me a medical necessity letter which I took with me to my
surgeon. My surgeon then included that letter with his own. Since you
have a wait before your consultation, I would start gathering any
information that your insurance company would need. GOOD LUCK!!
— sgibson71
January 31, 2002
Kendra, I have an Aetna HMO. I called them and asked that exact question.
You need to tell them the exact diagnosis and procedure codes that you want
approved. (If you look on this site under one of the first footprints, they
have the codes. Unfortunately, the procedure code that my surgeon uses was
not listed. {I just called the Dr's office and asked for the codes})
Anyway, they told me that the information on "medical necessity"
for those codes needs to come from the SURGEON, NOT my PCP. Since my PCP
said he is all for it, I had wanted to go to my first consult with the
approval in hand also. But, no go. Now, all I can do is wait for the
initial consult! I would suggest that you make some phone calls, and you
will have you answer! GOOD LUCK!!!
— Lauren C.
January 31, 2002
Kendra, I have an Aetna HMO. I called them and asked that exact question.
You need to tell them the exact diagnosis and procedure codes that you want
approved. (If you look on this site under one of the first footprints, they
have the codes. Unfortunately, the procedure code that my surgeon uses was
not listed. {I just called the Dr's office and asked for the codes})
Anyway, they told me that the information on "medical necessity"
for those codes needs to come from the SURGEON, NOT my PCP. Since my PCP
said he is all for it, I had wanted to go to my first consult with the
approval in hand also. But, no go. Now, all I can do is wait for the
initial consult! I would suggest that you make some phone calls, and you
will have you answer! GOOD LUCK!!!
— Lauren C.
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