I've got a date.. but not yet approved???!

Well, my surgeon's office called me today with a date 4/18/07!

But what the doctor's assistant did tell me was, that she talked to the insurance company today and they said that there is a clause in my policy that says they can deny the surgery because I have no co-morbidities.  However, the assistant said they are pushing it through to be reviewed anyways because of my high BMI.. she said it is possible to be approved because the BMI is so high (even with no co-morbidities).  So I am keeping my fingers crossed.  But has anyone heard of a doctor's office giving you a date -- without the insurance saying it has been completely approved?

I am praying that this goes through without any hitches... I have Carefirst BlueChoice, and I've heard they are pretty good about approving...  I guess we shall see.

Kelly

Hi Kelly. Well, your surgeon's office giving you a surgery date without approval from your insurance seems backa**wards to me.  Unless you've made arrangements to pay for your surgery yourself, they are holding a surgery slot for you without even knowing if the surgery is going to be paid for. My surgeon wouldn't give me a date (I should be getting a date tomorrow) without 1) receiving approval from my insurance (unless I was paying for sugery out of my pocket), 2) paying the balance I had to pay out of my pocket for their program (dietician, counseling, etc) and 3) without a completed clearance form from and signed by my primary care physician saying I am okay for surgery.  But hey, what works in my world may not apply to anyone else. Good luck.

Kelly, My surgeon's office will not schedule a date until they have insurance approval in hand.  I have heard of other surgeons who do schedule it earler in anticipation that they will get the OK in time. About your comorbidities-you mention in your photo on your profile that you have pre diabetes.  I have heard the term before but do not know  exactly what it means, but I assume that info was included with your request. Good luck!

Yes, the prediabetes was mentioned.  However, the insurance doesn't like the word "pre" and they said it isn't considered a comorbidity until it is actually diabetes.  I even had my doctor use a fancy term like "increased glucose tolerance".

Thank you Paul.  I am taking it as a sign to be optimistic.  And yes, she did make a comment about it possibly being approved with my BMI alone.  She said that it was just one of the insurance reps, and that a doctor with the insurance co would still have to review the file.  I am with carefirst, and I looked up the policy before, with your advice, and I printed it out.  I am going to go review it today, and see what it says. Thanks for your help again!!

I did get a tentitive date for my surgery before i was approved by surgery. It was canceled because i was denied but i am appealing. When we send in the appeal they will give me a new tentitive date.

My surgeon scheduled my date 3 weeks prior to getting my CIGNA approval. That's because I did everything my surgeon asked me to do -- including 6 month diet, nut, psych, endo, cardio -- and had a 41 BMI. They felt they were secure because my policy does not exclude WLS and they were right. I had a vertical sleeve -- the first CIGNA approved -- I believe primarily because the surgeon's office put together a perfect package and I made sure that each time CIGNA conveniently LOST the package, I had it resent until ultimately I personally sent the package FEDEX, return receipt. Got approval 3 days prior to surgery but my date always held. The surgeon's office just contacted CIGNA in the beginning of the last 5 days for an expedited approval due to pending surgery date.

Yeah, I did everything they asked too.  And apparently they are pretty sure they will get the approval they need.  She did tell me it was a tentative date, but I am hoping everything goes as expected, and they get an answer in the next few days.  Surgery date is only 16 days away!!!