Covering 6 month requirement for insurance

[xoxomaya 4]

I had my first consult with a surgeon last week on July 28th. Then I was contacted by his Patient Program Coordinator with info on how we will proceed to get me to surgery. When I initially spoke with her over the phone, she said I will need 4 monthly appointments with a nutritionist. And that I should be able to get surgery scheduled for December. I really want to get it done before the end of December.

She then sent me a lot of forms and literature to go over. One of the brochures she sent listed what each insurance requires. My insurance requires 6 monthly visits with a nutritionist.

I asked her about it since she only mentioned 4 monthly appointments over the phone. She said that she counts my initial appointment with the surgeon last week as 1st appointment and she will use his notes to submit to insurance. Then Aug, Sept, Oct, and Nov appointments with a nutritionist. And then the final visit with the surgeon in December to pick surgery date will count as 6th visit.

She definitely sounds like she knows what she’s doing. She seems very organized and efficient and basically told me if I follow her schedule, do all of my appointments with a nutritionist and other doctors I need to see to get clearance etc, I shouldn’t have any problems and should be good for December date.

I am little concerned about only having 4 actual appointments with a nutritionist which may be a problem at the end. On the other hand, I am not her first patient with my insurance and I do think she knows what she’s doing.

My concern with not getting December date and that I would end up paying my high deductible for both 2020 and 2021, AND I can’t take time off work between Jan and end of April, so if I don’t get December, I will have to wait till May.

Has anyone seen this before? Do you think this will work to cover insurance requirements of 6 monthly appointments? Any thoughts?

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[New&Improved 1,780]

I would ring your actual insurance first up then find out if you can even schedule a nutritionist straight away sometimes you have a wait list...

It's all up to insurance not her, they are the ones paying and approving everything...

[Recidivist 1,141]

My surgeon communicated directly with my insurance company to advocate on my behalf after they initially refused. I would trust that your surgeon knows how to present information to your insurance company to make sure that you will get approved.

[ebbii0927 42]

I had my first consult with a surgeon last week on July 28th. Then I was contacted by his Patient Program Coordinator with info on how we will proceed to get me to surgery. When I initially spoke with her over the phone, she said I will need 4 monthly appointments with a nutritionist. And that I should be able to get surgery scheduled for December. I really want to get it done before the end of December.
She then sent me a lot of forms and literature to go over. One of the brochures she sent listed what each insurance requires. My insurance requires 6 monthly visits with a nutritionist.
I asked her about it since she only mentioned 4 monthly appointments over the phone. She said that she counts my initial appointment with the surgeon last week as 1st appointment and she will use his notes to submit to insurance. Then Aug, Sept, Oct, and Nov appointments with a nutritionist. And then the final visit with the surgeon in December to pick surgery date will count as 6th visit.
She definitely sounds like she knows what she’s doing. She seems very organized and efficient and basically told me if I follow her schedule, do all of my appointments with a nutritionist and other doctors I need to see to get clearance etc, I shouldn’t have any problems and should be good for December date.
I am little concerned about only having 4 actual appointments with a nutritionist which may be a problem at the end. On the other hand, I am not her first patient with my insurance and I do think she knows what she’s doing.
My concern with not getting December date and that I would end up paying my high deductible for both 2020 and 2021, AND I can’t take time off work between Jan and end of April, so if I don’t get December, I will have to wait till May.
Has anyone seen this before? Do you think this will work to cover insurance requirements of 6 monthly appointments? Any thoughts?
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I was able to get a previous appointment with my regular doctor picked up as 1 of the 6. The insurance is ticking boxes. There is plenty of help getting the info. As far as ticking the boxes, its by any method that works. Don't worry about the means as much

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[xoxomaya 4]

Thank you
This makes me feel better

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[New&Improved 1,780]

Well I've heard all kinds of versions about what insurance companies can do or say or change the rules

[BigSue 1,320]

I would guess that your surgeon's office is pretty well versed in the insurance requirements. They do this all the time. It might help to ease your mind if you can get the actual fine print from your insurance policy (you may have to call or e-mail the insurance company for this).

I had some concerns about my ability to meet the requirements for my insurance, and my surgeon's office looked up the requirements and said, "Don't worry, we'll get you approved." And they did! It was a lot easier than I expected. I got denied initially because my insurance company changed their requirements while I was in the process, to add a requirement for a letter from my PCP saying that I was medically cleared for surgery. My surgeon's office provided an example letter to my PCP, and I was approved in less than a week from my PCP's letter.

[RickM 1,747]

I would generally go with the advice of your surgeon's patient coordinator, as they have been through these hoops before, particularly if it is with a common insurance carrier in your area. If your surgeon has a dedicated insurance coordinator, who handles all of the insurance issues, that would be a better person to get an opinion from, but that might also be the patient coordinator that you have talked to - it's worth checking out to make sure you are getting the best information.

You can verify this by calling the insurance company's customer service line, thought those reps don't always give the correct information (sad, but true.) The best thing is to look up the company's policy bulletin for bariatric surgery on their website which will spell out all of the specific requirements - that is their legal document that they must follow, irrespective what a customer service rep may say (but the doc's insurance coordinator should know all of the in's and out's of the language in it.) For instance, with my company, they implied that they wanted six monthly appointments, but did not specifically state that. Between my schedule and my PCP (who was my "medical supervisor" for this) we were only able to work in four appointments over the six months, and that was fine. (The insurance coordinator was concerned about how the PCP wrote up the report for it relative to the insurance requirement, but that was a different issue.)

If your insurance requires simply a "medically supervised" six month program like I had, then the first and last months being with your surgeon and the others with an RD should be fine. but if they specifically require six monthly meetings with an RD (nutritionist), then is won't. It's all in the wording.

Good luck on getting through all of these hoops - this is often the hardest part!

[2021NewMe 60]

I also have my appointment in December I did not think about the insurance and deductible that I would have to pay if the surgery lands on January 2021. I am so glad I joined this website I am a new member and I been reading and reading and I am so happy to see there is other people like me. I would feel like I was the only one dealing with weight issues and to see there is so many people that are going threw what I am and have questions and have feelings like me makes me feel hopeful and encouraged.