Question:
Should I call and find out if they will cover surgery before going to appt.?

Should I go ahead to my appt. and have them submit papers, or call ins co myself to see if surgery is covered. This will save time AND money. I just know I will be disappointed.    — Judy W. (posted on March 21, 2001)

March 20, 2001
I called my insurance ahead of time just to find out if an exclusion exists. They stated that I have to be TWICE my ideal weight (not just 100lbs over), but advised me to have the doctor's office submit anyway because they'll usually make exceptions if the doctor feels it is medically necessary. I haven't had my appointment yet, but I've read about others on this site who were approved despite what they were told by the company when they called. I'd advise you to call just to make sure they don't have a written exclusion and to find out what their criteria are so you're prepared, but let your surgeon submit the paperwork. The most money you're wasting if they deny is the co-pay for the initial consultation.
   — PT LawMom

March 21, 2001
Judy: My surgeon's office sent me an info packet first. They asked what insurance I had, and sent me a sheet on what my insurance required in order to get approval. If you have a common insurance carrier, I bet your surgeon's office will know the answer and can give you direction. Mine required 3 months of physician supervised weight loss in past year, a psych exam. And the surgeon's office required all my medical records to be sent to their office for the past 5 years before they wanted to see me. This helped expedite my process.
   — Cindy H.

March 21, 2001
You shoudl definitely talk w/ your insurance company. What you want to have is a copy of your benefits. If this is through an employer Human Resources can get you that stuff or ask your insurance company to send it to you. You will want to look under limititations and/or exclusions and see what they say if anything about Obesity. Good luck with everything. Feel free to email if you want.. I have worked in the insurance industry in Oregon for over 8 years now. I can't help everyone but I understand insurance very well. Dawn
   — Dawn R.

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