Question:
How can we find out which drs. take which insurance policies so that we can choose
There is so much confusion regarding which insurance policies will even cover wls as medically necessary that it might be easier for some of us if we could choose our surgeon according to which insurance policies they are accepting. I found the insurance list on which some commented about their personal experiences with specific insurance companies, however, it would be helpful if the wls surgeon lists for each state included the current insurance coverage they accept. Several times now, I have had my referral info sent over to a wls surgeon only to discover later that they don't cover. I'd like to know beforehand, before I even have my referral sent to a particular dr. This actually includes in-state and out-of-state, since some people, it seems, do have their surgery out-of-state and/or out-of-country. Some of us would like to have the option of self-pay, but we simply do not have that option. — catly (posted on January 25, 2004)
January 24, 2004
This will be no easy task! I think your best bet is to do research in your
area as to what Dr's perform this procedure. Once you have that list, you
will need to call their offices to see what insurances the medical group is
credentialed for. What happens is that Dr's can bill under a credentialed
provider in their medical practice. Example: My surgeon moved to my state
from Texas right before he started performing surgeries. The insurance
credentialing process takes very long. Therefore, he will start seeing
patients and bill your insurance as a secondary dr and the primary dr would
be one from the practice that is credentialed with the insurance. I hope
it helps! Good luck! Evelyn
— earana
January 25, 2004
Lauren, I think you are looking at the insurance policies backwards. If you
are insured by an insurance company that has a network, by all means check
with your customer service department or look in your insurance information
to see what surgeons are in network. I work for an organization that is
self insured, and I can tell you that doctors go into - and out of -
insurance plans. Just because it says on obestityhelp.com that a surgeon
accepts your particular insurance, that can change, so you MUST make sure
the surgeon is still in your network when you start looking at coverage.
Also, you need to know if your policy covers out of network surgeons and
facilities, or out of state surgeons and facilities. Start with the
insurance company! We have also dealt with doctors offices that don't know
if they are in or out of our network! (If the doctor or surgeon's office
does not submit the paperwork for credentialing or re-credentialing, they
can be dropped from the insurance network. This is not necessarily at the
end of a calendar year, which is why you really need to go to your
insurance company for information!)
— koogy
January 25, 2004
Aso, very few WLS surgeons are part of any insurance plan. In most cases,
this surgery is "out of network" even for HMO's.
— M B.
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