Insurance Approval Questions

[contrabanded 18]

Hey all,

I am in month 4 of 6 for the pre-op supervised diet before I can apply for surgery approval. With the way things are lining up, I will be approved (hopefully) sometime in December. However, I want to push my surgery date back to January for 2 reasons. 1) I will be able to switch to the low deductible high premium plan my work offers to hopefully make my money stretch a little further and 2) I'd rather start fresh with the new year and after the holidays. Only problem is I know you have to get re-approved for the lap band during a new calendar year even if you were already approved, so I have some questions:

1) How likely is it that I could be denied reapproval after the new calendar year starts? Is that a risk I should be careful taking?

2)I had to call my insurance rep the other day to figure out how much I will have to pay the psychologist I have to see and make sure he is in network. I started to ask the rep questions about the approval process and applying for surgery and she referred me to a "bariatric team" that Humana has. My fear is that if I call them and ask questions about the approval process before I submit the claim with the help of my doctors, that it will hurt my chances of getting approved instead of help.

I would love if anyone has some thoughts or helpful information!

Thanks guys!

[☠carolinagirl☠ 18,722]

any questions dealing with insurance denials or approvals should be with the insurance company themselves. have your items ready for when they ask. you are in control so dont take (no) for an answer.

[Jim1967 3,569]

So are you actually changing insurance companies or just coverage levels? Every insurance company seems to have their own policies. I would see if you could do a side by side comparison to know the pros and cons regarding making the change.

I would be very careful about making insurance changes. Make sure you have the policies in writing to ensure they are going to cover everything you will need. It will really suck if you change just to find out they won't pay for it. I cannot stress the importance of getting everything in writing.

My answer to question

1) is its hard to decide without all the facts in writing. Assuming the coverage is the same and only the cost is being affected then fine but other than that I would not risk losing the band.

2) You have every right to call and ask questions. You should not be denied asking about coverage. As for actually applying I recommend leaving that to the Doctor's staff. They will be far more knowledgeable seeing that they work with insurance companies all the time.