Weight Loss Surgery - Insurance Approval




View Full Version : Insurance Approval


Valarie250
10-11-2005, 04:50 AM
Open Poll :)

I have recently sent in my papers and am awaiting approval- I am 250, 43 BMI and have PCOS. I have been trying to lose weight in a supervised setting since I was 10- I am now 22. I am wanting a Roux-en-Y bypass.

I was wondering how long it took you ladies from sending in paperwork to insurnce approval, then to surgury.

Thank you so much for taking time to ease my mind a bit :grouphug:


jiffypop
10-11-2005, 08:26 AM
nice dog!!!!! she [or he!] will be a huge help after surgery. ALWAYS ready for a walk ...

as for the approval, i'd suggest calling the ins company after a week [not more than 2!] to make sure that they have everything they need. in most states, they're required to provide an answer within 30 days, but that answer can be 'we didn't have enough information.' and then you have to resubmit and WAIT again. you don't need that.

sooo, welcome aboard! hang out with us! ask questions!

jiffypop
10-11-2005, 08:28 AM
oh. next question. the time to surgery completely depends on the surgeon. some schedule it at at the same time as the insurance submission [because they also have a backlog, and if you're denied, they can always bump up someone farther down in the pipeline]. some people wait as long as a year, others a few weeks. talk to your surgeon.


janet_921
10-11-2005, 09:23 AM
Valarie,
I was one of the lucky ones...I waited 3 weeks for approval and had my surgery...2 days later..
Hang in there and good luck!!
Janet

Chickadee
10-11-2005, 12:07 PM
It also depends on the insurance company. I waited for eight long weeks to get an answer. When you call them, get the name of whoever it is you've talked to and keep notes. It was very helpful to me. My surgery was scheduled for three weeks after my approval came.

In the meantime, while you're waiting, continue to do lots of research and reading about WLS so that when the time comes, you'll be one encyclopedia of WLS knowledge.

Chickadee

Stevie Christine
10-12-2005, 12:07 AM
Approval means nothing. It is n-o-t a promise of full coverage. With Blue Crud, I had to pay the doctor up front and get reimbursed by Blue Crud. It was a $12,000 surgery, and I received $1600...even though I was told on the phone by one of their employees (I gave them her name) that my surgery would be fully covered. She still has a job, and I'm out some bucks.

Approval is only a word that says, "You may get sliced and diced, but we may or may not keep our promise to pay."

Buyer beware.

Here come the negative comments from the peanut gallery!!!!!!!!!!!!!! Waaaaaaaaaaah!

Valarie250
10-12-2005, 05:22 AM
I want to be sure we're discussing the same process- by approval I am refering to the actual insurance company, in my case Aetna, sending an offical answer - perhaps in letter form? - as to how much of the procedure will be paid for. I am a college kid, so Christmas break would be a great time to rest and relax after surgury- otherwise, I'll have to go to class while I recover! My point in asking was to see about how long some people took so I could average the information to guess-timate as to whether or not christmas will be too soon :) Any info you ladies can give me will help me while I await my visit with my doctor and all of the insurance hassles...

Stevie Christine
10-12-2005, 09:07 AM
That's an Explanation of Benefits (EOB).

Valarie250
10-12-2005, 06:15 PM
Stevie-

I'm not sure what the difference is. An explanation of benifits- is it the same as approval? How do you know when eveything is official? My doctor's office does all of the negotiating with insurance (after he has aproved you...) so I'm not dealing directly. :?:

Stevie Christine
10-12-2005, 07:29 PM
I never saw an approval letter. That went to the doctor. The EOB tells what the insurance will cover...maybe.

I am quite bitter that I got lied to and screwed. Don't let it happen to you.

Valarie250
10-17-2005, 03:16 PM
I got some good news and some bad today. The doctors office called to let me know that my insurance will not cover ANYTHING! :cry:

This was crushing at first- but there seems to be a light at the end of the tunnel! My husband went to negotiate with HR at work and it looks like we will be able to switch from our EPO to a PPO, which should cover about 90%. :cb:

Also, my mom has stepped up to the plate- she said she would cover whatever insurance does not... now I'm back to waiting! Additionally, I got to find out from the ladies at my docs office what exactly is needed for approval- I have everything they require! Doctors records showing 6 mo of diet and exercise, co-morbities, 5 years (try 15!) of obesity... Lets hope they'll fix his insurance soon... there are other problems besides this, so it might happen...


So, even though I have a setback, things look pretty hopeful.
Anyhoo, keep those warm thoughts and prayers coming!

Valarie :)