Question:
Does this mean I won't get approved for the surgery?

I saw my surgeon, have had my psychosocial eval, nutritional consult, and have apts scheduled with my PCP and a cardiologist. My surgeon said at the first apt that he was certain that the insurance would pay--over 400 lbs, several co-morbidities, history of weight loss attempts. He said that he first gets a surgery date lined up and then puts the request through to the insurance. I'm confused: I got a letter on Friday, stating that the surgeon has already submitted a bill for the initial consult. At the bottom near "This is not a bill", the Blue Cross PPO states, ..."not a covered benefit." Should the surgeon's office have submitted this already based on what he told me before? And does this mean the insurance is going to deny the surgery? It's Blue Cross PPO/California Care/Prudent Buyer through my husband's employer. By the way, I can find nothing in the benefits book that says this type of surgery is excluded. I'd *greatly* appreciate feedback!    — CaseyinLA (posted on May 20, 2001)

May 20, 2001
I have BC/BS Preferred of Alabama and I was told before I had my initial consultation with my surgeon that BC/BS usually doesn't pay for the initial consultation, in fact I had to pay for my first two appointments myself. However, they did pay for the actual surgery, I didn't even have to get pre-certification since my surgeon deemed it medically necessary. I would have had to pay the consultation fees whether or not I was approved by the surgeon or the insurance company. I would suggest you call the insurance person at your surgeons office and visit with them regarding what is and is not covered with your policy, they usually have a pretty good idea. Good luck with your approval.
   — debathens