Insurance verification

[Dnise 0]

How does insurance verify that you met all the requirements for surgery. Do they base it on what is submitted or do they call your PCP to verify. Just wondering the process as this may determine how long the process takes.

[Puffy-no-more 141]

The surgeon sends everything in to the insurance company when it is all completed and they are requesting a prior authorization. If insurance decides they need further information, they contact the surgeons office.

[BayougirlMrsS 3,933]

2 hours ago, Dnise said:

How does insurance verify that you met all the requirements for surgery. Do they base it on what is submitted or do they call your PCP to verify. Just wondering the process as this may determine how long the process takes.

My suggestion to you is to start the process yourself. Call your insurance provider and ask what the requirements for WLS if any. This can help get you in the right direction. My old insurance required a 35bmi w/2 comorbidities or a 40bmi. I didn't have any co's so i had to have a 40.... which i was just shy of back then. So before i even went to the seminar, i put on 10lbs. (gained 10 to lose 89... hell yes). I knew i would be approved.... My Dr. arranged all the appts. to heart, lung, phyc., sleep test, NUT... etc. After he got ALL the results back he submitted as one packet WITH a SX date. I was approved in three days. I had already researched the band for months before, but from the day i went to the dr and SX day it was around three months.

I got my GYN to submit info on my health and weight gain over the years and i also has my logs from WW to show my dieting attempt.

[curvytiff 10]

23 hours ago, BayougirlMrsS said:

My suggestion to you is to start the process yourself. Call your insurance provider and ask what the requirements for WLS if any. This can help get you in the right direction. My old insurance required a 35bmi w/2 comorbidities or a 40bmi. I didn't have any co's so i had to have a 40.... which i was just shy of back then. So before i even went to the seminar, i put on 10lbs. (gained 10 to lose 89... hell yes). I knew i would be approved.... My Dr. arranged all the appts. to heart, lung, phyc., sleep test, NUT... etc. After he got ALL the results back he submitted as one packet WITH a SX date. I was approved in three days. I had already researched the band for months before, but from the day i went to the dr and SX day it was around three months.

I got my GYN to submit info on my health and weight gain over the years and i also has my logs from WW to show my dieting attempt.

Agree 100%. I called my insurance to ask if I was covered, and they provided the full coverage policy for gastric sleeve. This helped a ton! When my bariatric place did the initial check on the insurance they said that I was not covered and would have to be self pay. I told them that I had already checked with my insurance and that they should try again. Come to find out I was covered and the person she spoke to thought she was checking on plastic surgery vs. bariatric surgery.

[BayougirlMrsS 3,933]

21 hours ago, curvytiff said:

Agree 100%. I called my insurance to ask if I was covered, and they provided the full coverage policy for gastric sleeve. This helped a ton! When my bariatric place did the initial check on the insurance they said that I was not covered and would have to be self pay. I told them that I had already checked with my insurance and that they should try again. Come to find out I was covered and the person she spoke to thought she was checking on plastic surgery vs. bariatric surgery.

yeahhhhh good for you...