INSURANCE

[dtietjen 1]

I am trying to clarify some insurance requirements. I get different things from my pcp and bariatric dr. First I have western health advantage (mercy medical group). I am told I have to be followed by the surgeon and his staff for 6 months. I have to see the dietician first and do my phsycological evaluation before I can see the surgeon. Can someone please clarify.

[allwet 868]

six monthly appointments is a very common requirement

everything in your post in normal.

Edited July 27, 2018 by allwet

[Briswife15 889]

Clarify what, exactly? I have Anthem BC BS and I also have to be followed by the surgeon and nutritionist for 6 months, have a psych evaluation, cardiology visit, stress test, and attend two support group meetings, and have a barium swallow test. Like allwet said, it all sounds completely normal and expected. Are you getting two different sets of requirements depending on the doctor? If so, I'd go first with what your insurance requirements are. Then your bariatric surgeon shiuld do what insurance requires.

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[RickM 1,747]

You need to look at what your company's policy bulletin specifically says - it should be posted somewhere on their website or you can call them (and hope the rep tells you the right thing!) The policy bulletin is the legal requirement that you and they have to follow. Your surgeon's insurance coordinator may be able to help as they know the lingo and how to read the policies.

Typically, these insurance diets are to be medically supervised, which can mean your surgeon, PCP or an RD (dietician), and sometimes a structured program like Weight Watchers is acceptable - you need to see what the policy bulletin states. I used my PCP for my diet and that went through fine.