Question:
Surgeon submitting request for Authorization - I have a question
Hello! I've been lurking around this message board for the past few months, but this is my first post. I had my consult with the surgeon on Friday. When I got there, he had not received any of my medical records yet. I did have a copy of my sleep study results with me, but other than that, all he had to go on was the paperwork that I had filled out listing my weight history, comorbidities and previous attmepts at weight loss. I am 5'2 230 BMI ~42 with severe Obstructive Sleep Apnea , hypertension and reflux. I am on a c-pap for the apnea and take medication for both the reflux and hypertension. I told him my insurance does cover the surgery if it is medically mecessary (a coworker had it last year). The surgeon told me he did not need to wait for the medical records and that he would be sending a request for authorization out to the insurance today! He said that the sleep apnea is pretty much an automatic qualifier. Is this normal? Don't they (surgeons) normally want to see all of your supporting documentaion first? Can it really be this simple??? Thanks in advance for your help! Barb — Barbara C. (posted on February 24, 2003)
February 24, 2003
Hi Barb. My surgeon did the same thing. He wrote a letter. He said being
morbidly obese qualified me right there. And you know what,he was right. I
was approved in a week without having to submit any other doucumentation.
Surgery date is March 14th.
— Debbie W.
February 24, 2003
Barb - Count yourself L-U-C-K-Y!! I had my first appointment with the
surgeons office in SEPTEMBER. I took a letter of recommendation from my
primary physician to this consult. Since that time I feel like I'm a well
trained poodle hopping through this hoop and that hoop and then another.
AND ... the insurance approval seems to have been lost in the shuffle as
well, so was resubmitted a week ago. On Friday, my latest hoop jumping
test -- they did go ahead and give me a surgery date. But it's not until
MAY. I'm so discouraged about how long it takes. So I'm really truly
happy for someone like you that it seems to be going so easy for. UNLESS
OF COURSE YOU ARE A PATIENT OF MY DR. and didn't have to do the hoops!
Sorry to whine ... Signed "FiFi" oops - I mean Allee
— Allee Z.
February 24, 2003
I think most surgeons will take the patients word for there past history.
They just need the paperwork just in case an appeal is needed or if the
insurance wants then to send proof to them. I had all my past med records
sent to the doctor and wrote a letter to him myself as I knew I would be
nervous. It turns out that I was nervous and forgot to mention what was
written in the letter and he only used the information I had verbally told
him for my approval letter to the insurance. I know he did not even read
the information I sent. Or maybe he did- I don't know- what counts is that
you surgeon is confident that you will be approved and that is a good sign.
They usually know this stuff. Good luck I am sure all will go well.
— Jan S.
February 24, 2003
You don't say which insurance you have but I do know that surgeons who do
this surgery all the time know what each one expects and the have their
favorites too. Some insurance companies are very quick to approve. Mine was
done with the first phone call. Good Luck!!!
— Carol S.
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