Was your DS surgery out-of-town, if so were you able...

 How did the insurance process go for you?  I had an appointment set for Thursday to meet with a surgeon who performs sleeve, rny, and band...I guess I should put that on hold...

Relatively nightmarish.

First they said that it HAD TO BE at a CoE.  Interestingly enough, there was not ONE CoE in CA that had a surgeon performing the DS.  I sent them a list of their CoEs and the names of the surgeons doing bariatric surgery at each and either a copy of the email they sent saying they didn't do the DS or a phone number for the insurance company to call to ask on the phone.

I did not go through the approved appeal process.  I sent an email to the insurance company's medical director.  He wrote this:

Hello - there are many hospitals in our network and we can provide
transportation, if that is needed, to a hospital and surgeon who
will perform a procedure if he/she agrees you would be better off
with the procedure you think or have been told is better


Meanwhile, Keshishian's office submitted and the insurance pre-authorized and I got a copy of the pre-auth.  Then I had surgery and they denied the charges and said they didn't MEAN that they were going to pay for it.  So, not wanting to be "just another customer," I found a way into their legal department and bugged someone there for an explanation of why they felt they NOW had a right to deny a claim they previously pre-authorized.  And they said they didn't really mean THAT either and then they paid.

No, don't put it off.  Be prepared for a sales pitch, but FIRST get approved for ANY wls.  You want the fight with the insurance company, if you have one, to be as focused and limited as possible.  So you want them to approve wls.


This conversation is attributed to several famous and funny men:

Man (to pretty lady at dinner): Would you sleep with me for $52 million?

Pretty lady (laughing): Of course!

Man (leering wildly): How about for $10?

Pretty lady: Sir, what do you take me for?

Man: We've already established what you are.  Now we're just haggling over price.

We already know WHAT the insurance company IS...we want to get them into a situation where they're "just haggling over the price."

Yup, I had everything done locally except for my actual pre-anesthesia stuff--the chest x ray, labs, physical etc. that are required prior to admission. All the tests and exams and stuff for surgery clearance were done near home.

I will be traveling for my DS which is approvABLE by my insurance...they just haven't decided to approve ME yet! I know I will have to pay for accomodation and transportation, but if the insurance is covering everything else, no biggie. I am getting all preliminary work done at home through my awesomely- accomodating PCP. Find one BEFORE a DS, please.

Usually, when insurance "sends" you out of town for a procedure thay cannot provide locally, they also contribute for mileage and hotel.  Check your policy's small print.

ETA:  And don't mention that part until AFTER they approve everything else.

If you have a Flex Spending account (Sect. 125 Medical Reimbursement), then you can use those funds to pay for a hotel and mileage to and from the surgeon.  The hotel at the time of my surgery was reimbursed to $50, I think ... not that much, but better than nothing.  Mileage reimbursement changes, but you can check with your employer.


Jc

Dr Maguire did my revision. I traveled 1200 miles. I had blood work done at home, the endoscopy was done by Dr Teel ( Dr Maguire's partner)  in Ohio before the revision. It really depends on the individual doc. Ask them what they want. Do what you have to as it is worth it.

Do you know who you want to see ? Are they a vetted DS doc ? 

 I want to go to Dr. Sudan in Durham, NC...I have a lot of family there and I once lived there too. This will not be a revision for me, do you think that will make the approval part harder...I have a 48 BMI and pre-diabetic (no meds) and back pain (MRI showed arthritus in my back)