Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Insurance and Dr's office discrepancy



Recommended Posts

Any body have your insurance tell you one thing and your Dr tell you something different about the pre-approval requirements. In Nov the insurance company told me 6 months and my Dr said the same in Dec. A few weeks ago my Dr office called and said I only needed 3 months. I got excited but now I can't verify that info with my insurance company. I have Anthem BCBS GA. Anyone have a similar situation.

Share this post


Link to post
Share on other sites

I have Anthem BCBS CA , my doctors office told me 6 months . Tomorrow I'm going to call my insurance and see what the requirements are . I guess I will see if it's the same

Share this post


Link to post
Share on other sites

I have Anthem BCBS CA , my doctors office told me 6 months . Tomorrow I'm going to call my insurance and see what the requirements are . I guess I will see if it's the same


The ins company told my Dr that my plan pays under BCBS local and it only requires 3 months. I'd never heard of a plan paying differently than the type of plan you are a member of.

Good luck and hopefully no issues ahead.



Share this post


Link to post
Share on other sites

The doctor office told me 6 month and insurance verified that I only needed 3 months. My policy was unique to my employer. I have Anthem BCBS their standard policy is 6 months of visits. The lady at the doctor office said she never heard of it. So I had the insurance company send a verification letter to me and I forwarded to the doctors office.

Edited by blessedgirl80

Share this post


Link to post
Share on other sites

I have Anthem BCBS CA and I was required to do 6 months. My bariatric surgeon's office called my insurance to verify that during my consultation


Share this post


Link to post
Share on other sites

Same happened to me. I think when you have insurance through your employer, the specifics of the policy can differ depending on what the employer and insurance company agree on.

Share this post


Link to post
Share on other sites

Almost every employer-based policy is different, particularly if you work for a really big (e.g. Fortune 500) company. They have negotiating power with the health insurers. Never assume that because someone else who was insured by the same company got a certain answer, that answer will apply to you. They may have had a very different policy. It's one thing that 25+ years of practicing law has taught me.

Share this post


Link to post
Share on other sites

Same happened to me. I think when you have insurance through your employer, the specifics of the policy can differ depending on what the employer and insurance company agree on.


That's what they told me today. The utilization management dept called me back today and conformed that my plan doesn't have a specific time frame and that it is based on how my Dr thinks I've progressed. I must being doing good because they submitted everything yesterday so now I just wait to see if I get approved!



Share this post


Link to post
Share on other sites

Almost every employer-based policy is different, particularly if you work for a really big (e.g. Fortune 500) company. They have negotiating power with the health insurers. Never assume that because someone else who was insured by the same company got a certain answer, that answer will apply to you. They may have had a very different policy. It's one thing that 25+ years of practicing law has taught me.

That's what my ins peeps told me today. They finally called back and said my plan is different and there's no set time frame. I'm waiting now to find out if I got approved or not.



Share this post


Link to post
Share on other sites

The doctor office told me 6 month and insurance verified that I only needed 3 months. My policy was unique to my employer. I have Anthem BCBS their standard policy is 6 months of visits. The lady at the doctor office said she never heard of it. So I had the insurance company send a verification letter to me and I forwarded to the doctors office.

I didn't have them send a letter but they did confirm today that there isn't a set time frame for my specific plan. They did make notes in my file that they confirmed the info so now I'm waiting for an approval!



Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • ChunkCat

      I have no clue where to upload this, so I'll put it here. This is pre-op vs the morning of my 6 month appointment! In office I weight 232, that's 88 lbs down since my highest weight, 75 lbs since my surgery weight! I can't believe this jacket fit... I am smaller now than the last time I was this size which the surgeon found really amusing. He's happy with where I am in my weight loss and estimates I'll be around 200 lbs by my 1 year anniversary! My lowest weight as an adult is 195, so that's pretty damn exciting to think I'll be near that at a year. Everything from there will be unknown territory!!

      · 2 replies
      1. AmberFL

        You look amazing!!! 😻 you have been killing it!

      2. NickelChip

        Congratulations! You're making excellent progress and looking amazing!

    • BeanitoDiego

      I changed my profile image to a molecule of protein. Why? Because I am certain that it saved my life.
      · 0 replies
      1. This update has no replies.
    • eclarke

      Two years out. Lost 120 , regained 5 lbs. Recently has a bout of Norovirus, lost 7 pounds in two days. Now my stomach feels like it did right after my surgery. Sore, sensitive to even water.  Anyone out there have a similar experience?
      · 0 replies
      1. This update has no replies.
    • Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×