Hi everyone. Been lurking for a few weeks now reading lots of good info you all have provided as I do believe I'm gonna be taking the next steps to have the bariatric surgery. So my question is as follows (after some explaining)..............

The facility I will be going through had a video I had to watch on their website before I could even contact them about setting up an appointment. Which I did. After watching I filled out the online questionnaire for the office. Today they contacted me saying they would be sending the info to my insurance company. I didn't exactly know what they meant so I asked them if I had to be pre-approved BEFORE I could even get an INITIAL appointment and they told me yes. They said, "Yes, we need to confirm you have bariatric benefits as well as the requirements your insurance determined for the program. Once we call to go over this information we will schedule you for your first visit with the surgeon."

I found that strange as I know I DO have benefits and I DO meet the requirements as far as my BMI goes but otherwise, I have NOT yet done any sort of classes or further testing. So, I worry I will be denied from the get go if that's what they'll be looking for. Am I reading this wrong? Doesn't it sound as if they're already expecting I have everything done? At least that's the way I'm reading it. I felt like writing back and saying look, I'm just in my initial stages of acquiring info to see if I even WANT to go through with it. Why the heck do I need pre-approval FIRST for that? Has anyone else had things happen like this?

Hi! I’m a newbie too. Just started the journey a month ago. Different insurance companies require different things for bariatric surgery such as X number of dietician visits, procedure has to be done in a certain type of hospital (accredited or center of distinction etc). Some require certain Preop testing and may or may not require you to keep a food diary(that would be sent to them to get approval. So my guess is they are just going to get that info, not necessarily have you approved. Good luck!

2 minutes ago, TerriDE said:

Hi! I’m a newbie too. Just started the journey a month ago. Different insurance companies require different things for bariatric surgery such as X number of dietician visits, procedure has to be done in a certain type of hospital (accredited or center of distinction etc). Some require certain Preop testing and may or may not require you to keep a food diary(that would be sent to them to get approval. So my guess is they are just going to get that info, not necessarily have you approved. Good luck!

Yes, I understand that but as I've said, I have NOT done any of that as this is supposed to be an initial consult for me to get more info on the surgery itself. Not sure why I need to have all the testing, classes, etc. DONE BEFOREHAND, ya know? I would think they wouldn't put me, or expect me, to go through all of that unless and until I decide I actually want to go through with the surgery. I also fear that I will be denied from the get go since I DON'T have that stuff done.

I'm not saying you have to have it done beforehand. I'm saying that they are most likely asking your insurance company what is required in order to be approved for surgery (in the future). Calling for information only - not for approval. Then at your initial consultation with the surgeon, they will go over that with you and let you know that you would have to do X, Y and Z should you decide to do the surgery.

17 minutes ago, SummerTimeGirl said:

Yes, I understand that but as I've said, I have NOT done any of that as this is supposed to be an initial consult for me to get more info on the surgery itself. Not sure why I need to have all the testing, classes, etc. DONE BEFOREHAND, ya know? I would think they wouldn't put me, or expect me, to go through all of that unless and until I decide I actually want to go through with the surgery. I also fear that I will be denied from the get go since I DON'T have that stuff done.

They probably want to reach out to the insurance to see what the requirements are so they can tell you exactly what to do when you do go in. No need to go in if you don't know what is necessary after that visit.

1 minute ago, TerriDE said:

I'm not saying you have to have it done beforehand. I'm saying that they are most likely asking your insurance company what is required in order to be approved for surgery (in the future). Calling for information only - not for approval. Then at your initial consultation with the surgeon, they will go over that with you and let you know that you would have to do X, Y and Z should you decide to do the surgery.

Ok. I see. The wording she used definitely threw me off as it sounded like she was already expecting it to be done. LOL

1 minute ago, mweiss1998 said:

They probably want to reach out to the insurance to see what the requirements are so they can tell you exactly what to do when you do go in. No need to go in if you don't know what is necessary after that visit.

Yeah I guess so. Like I said above, the wording just threw me off because it almost sounded like they were expecting that I had already had the stuff completed. Guess I'm just reading it wrong. Thanks!

I'm going to politely disagree with the responses you've received here so far. Since even the initial consultation is a bariatric service, they want to verify that your insurance will cover it prior to scheduling. The initial consultation is a billable service. You either have coverage or you don't. The facility wants to know if insurance will pay or if you will be paying on your own. It is possible after the initial consult, that you choose not to proceed. However, they still want to know that you have coverage for that visit.

Example: my insurance policy through my employer specifically excluded any coverage for weight management and/or bariatric services until 2020. In 2019, I was aware that coverage would be added in 2020. I tried to schedule initial consultations and dietician visits to get started but was unable to unless I wanted to pay for them out of pocket. Since I did not want to self-pay. I had to wait until benefits began in 2020. Even having a conversation with my primary care doctor regarding any potential weight management had to be done as a discussion during an appointment coded as something else. Otherwise, I would have had to pay for it.

I hope this makes sense.

18 minutes ago, Maisey said:

I'm going to politely disagree with the responses you've received here so far. Since even the initial consultation is a bariatric service, they want to verify that your insurance will cover it prior to scheduling. The initial consultation is a billable service. You either have coverage or you don't. The facility wants to know if insurance will pay or if you will be paying on your own. It is possible after the initial consult, that you choose not to proceed. However, they still want to know that you have coverage for that visit.

Example: my insurance policy through my employer specifically excluded any coverage for weight management and/or bariatric services until 2020. In 2019, I was aware that coverage would be added in 2020. I tried to schedule initial consultations and dietician visits to get started but was unable to unless I wanted to pay for them out of pocket. Since I did not want to self-pay. I had to wait until benefits began in 2020. Even having a conversation with my primary care doctor regarding any potential weight management had to be done as a discussion during an appointment coded as something else. Otherwise, I would have had to pay for it.

I hope this makes sense.

Ahhh, ok. That makes sense and may be why she said what she said. I guess maybe they want to have a game plan already in place, based on what insurance says, so that during my initial consult they can tell me x, y and z will/will not be covered should you go through with it and this, that and the other needs to be done beforehand as well. Ok. So I guess this isn't too odd. LOL

Yes, that is normal. I did initial consults with two different doctors and they both did that beforehand.

I had to switch insurance companies in order to get bariatric surgery. I first contacted the clinic about six months before my insurance changed. They said I had to wait to start the program until i had my new insurance, but they did say I could start the six-month supervised diet ahead of time if I wanted, because they'd worked with my new insurance company before and knew they'd accept a six-month supervised diet done ahead of time as long as it was within the last two years (but this may not be true of all companies). So anyway, a long way of saying, I had to wait until I was under the new insurance and we knew everything would be covered.

Thanks again everyone for the info!

Soooo, I got an email today from one of the nurses regarding my insurance. Aside from telling me to wait for my "binder" of info to arrive se sent the following:

Deductible: $150

Met to Date:

Out of Pocket: $2750

Met to Date:

Copay:

Coinsurance: 100%

Medically Supervised Weight Loss Classes:0

My question is, and it's ok if you don't know I'm sure I will find out once the packet comes, but what does the "Medically supervised weight loss classes: 0" mean? That I've had none or don't need any?

I ask because in a separate email there were links to videos I must watch on nutrition and quizzes I must take and I also DO need to meet with a dietician and of course the surgeon. It also goes over all the testing I will need to have done.

I also wonder when the out of pocket money needs to come into play and if I can make payments on it and not need it all up front? Thanks!

Edited February 8, 20215 yr by SummerTimeGirl