Ok, I have done 4 of my 7 weigh ins...still need to do nutritionist appt, psych evalution, and sleep apnea...my question is at what point does the drs office normally submit to insurance to try for approval. My 7th weigh in will be mid-late April...my deductable started over June 1. Wondering what the odds will be to get band in that 5 week window.

Thanks,

Karie

This is all very new for me, I just had my very first consult appt today! Out of curosity, what are the "7 weigh ins?". This is the first I am hearing about "weighing in" with all of the reading I have done.

For me, I still have a nurse practitioner consult (tomorrow AM), sleep study (consult Thursday), and a consult with my surgeon (TBD after nurse practitioner clears me). I started the process on January 17 (had been scheduled since mid December 2011) and I am being told the process should go super fast due to very few insurance requirements. I am expecting to be banded sometime in February, maybe early March.

After cruising the boards for so long, it seems like many people are scheduled for surgery around the time they submit to insurance. I've seen some people be scheduled for two weeks after submission, and some up to 6 weeks. I guess it all depends on the Dr.

Maybe you should ask about the timeline at your next visit?

Most doctors cannot submit the request for approval until ALL the steps are completed. Depending on your insurance and more specifically, your policy, the approval process can take anywhere from a day to 6 weeks. My insurance did not require pre-authorization at all. They paid my doctor within 20 days of him submitting the claim, and I just received my EOB that they paid the hospital last week.

Some insurance companies cover the procedure, but individual employer policies may not. I would call your insurance and ask them exactly what their requirements are for the surgery based on your particular policy. Dont let them tell you that its just considered out-patient surgery, tell them you need the exact requirements for the surgery and how long they typically take to approve the surgery once the request is received.

I know this, because I work for a hospital, in the billing department, and have seen alot of claims come through that have been denied because the individual employer elected not to cover bariatric surgery on their policy. Hope this helps