Pre-op tests for Self-Pay Patients

clarityseeker · June 28, 2006

I may have seen some discussion about this before, but not on my specific issue. I am self-pay. I met with Dr. Spivak and he wants me to have an upper GI before having the surgery. I'm not even sure why. Anyway, I would like to have my insurance pay for it. So, I am going to see a gastro doctor and ask him to do it, but I am going to need a medical reason for it. I have heartburn occasionally, but I don't really have any reason to think that I have a problem with my upper GI tract. I have United Health Care. Does anyone have any experience in getting pre-op testing done with insurance covering it, even though you are self pay for the lap band? Any information is appreciated.

Tricia K. · June 28, 2006

My surgeon wrote the prescriptions for the pre-op tests in a way that my insurance would cover them all. I believe they were coded for fatigue. You may wish to ask Dr. Spivak to do the same.

FunnyDuddies · June 28, 2006

I have united health care, and though all I had done was blood work, they coded it for preop tests. United health care had no problems paying it. They have no idea what sort of surgery i am having.

Melissa Lea · June 28, 2006

Hi --

I too am self-pay, UHC, Spivak. I too had to have an upper GI. The reason for the UGI is to rule out any stomach ulcers prior to surgery and test for reflux disease (severity).

My UHC paid 100% for my upperGI, no questions asked. Luckily for me, I a PPO and Spivak could write the referral. No other doctor needed, whew!

Good Luck!

Melissa Lea

Spivak

06/09/06

Kathi · June 28, 2006

I had alot of pre-op testing, and I am also self pay. My PCP had no problem pushing through all of my tests and my insurance covered them all.

clarityseeker · June 28, 2006

Thanks for the replies.

Melissa -- I have UHC PPO, too. Who did your UGI?

Jessica

hoping to be banded in 8/06

Melissa Lea · June 28, 2006

Hi Jessica --

I used River Oaks Imaging http://www.riveroaksimaging.com/ (the one on Kirby). I also think Heath South is in Network. I called UHC and told them that I needed a Upper GI and I needed to know what outpatient facilities were in network and confirmed my coverage. These are the names given to me.

Once I decided on a place, I phone Spivak's office and they set up the referral and appoinment. I think Bee did that for me. Bee took my insurance info and provided it to River Oaks Imaging. I just showed up the day of my appointment and filled out some paperwork. The rest is history.

Hope that helps!

Melissa Lea

clarityseeker · June 29, 2006

Melissa -- thanks for the advice -- I did what you did and I'm scheduled to have the UGI next Wed. Dr. Spivak's office faxed me over an order and I scheduled it right away with River Oaks Imaging! You rock!:clap2:

Jessica

Melissa Lea · June 29, 2006

Good Luck to you Jessica. Let us know how your test turn out. And remember --think of the barium you have to drink as a nice, frosty milk shake!! It goes by fast.

Melissa