what to ask the surgeon's insurance coordinator?

Hi - I'm going to contact my prospective surgeon's insurance coordinator today. I'd like to ask her how my insurance covers the surgeon, hospital, etc. and get an out-of-pocket cost estimate. I'm in their bariatric system already and have started all the programs & appts (diatition, psych, weight-loss, etc.). What questions should I ask her about my insurance??? I already have a list of what the insurer expects of me to qualify (certain BMI, physician-directed weight-loss program for six months pre-surg, etc.). Thanks for any help you can give me.

I've found out I need to talk to my "benefits" administrator and ask for the amts for bariatric surgery co-pay, annual deductible, and annual out-of-pocket cap. How does that sound? Am I missing anything?

When I first started it was up to me to check with my insurance to see if they covered WLS surgery and specifically, the Lap Band.  Once that was done, I could make the initial consultation with the surgeon.  the only questions I had was the timeline.

Sue

 I found it extremely to contact my insurance company directly and ask them to send me a copy of their requirements needed presurgery for weight loss surgery.  If you do not meet all of these requirements, they will deny you.  Often times denial is very common the first round.  Do NOT give up.  That is what your insurance company would like because then they do not have to pay for surgery.  Appeal.  

Chances are very high that it will be approved the second time around.  Just don't get down if you get denied first off.  Also by having the insurance requirements, if they try to change requirements, you can fight them as to what was in effect when you started the process.  They cannot add to the requirements once you have started all the consultations.  

I just feel better when I do the research myself.  Not all coordinators that work for doctor offices know EVERY insurance policy and all of their ins and outs.  You may also want to find someone who has the same type of insurance for some tips.  There used to be an insurance forum on this site.  I don't know if it still exists but it really helped me.  I have Cigna and they are notorious for denying WLS  I got some excellent tips including what to document for the insurance company.   

@Nancy - No kidding, about Cigna? That's who I've got now. I was able to get the Cigna requirements, and boy, are they picky. I asked the surgeon's insurance lady if she thought I'd have to provide every shred of evidence that might still be in my possession (old med records, old food diaries, etc.). She said she didn't think so w/ Cigna. Seems she coached me to mainly do the doc-supervised program really well (like never miss a class, etc.). ---- Now, I'll call my insurance administrator about what's covered and what percent by Cigna for Northwestern Memorial Hosp and the bariatric surgeons there (check on co-pays, etc). I hope I can afford it! I know I'd cost Cigna less over time if I weren't at 47 BMI w/ a lot of comorbidities.

 The key with Cigna is documentation.  I had to redo my 6 month supervised diet because not every month was written correctly in my medical chart.  I devised a sheet that the doctor could make notes on each visit.  It provided space for weight, diet tried, exercise tried, any drugs tried, next plan.  You HAVE to see the doctor each month.  Cannot miss a calendar month.  My Cigna is with the State of Illinois PPO and they were really good in paying.  I had met all my deductibles for the year and they paid 100%.  But I was denied the first time.  That was due to some paperwork that my doctor's office did not submit.  Yes, you have to document EVERYTHING with Cigna.  The look for every excuse to deny you!  They expect you to roll over and play dead after the first denial, but if you pursue it, you can get them to pay on any procedure.  I have only lost with them like 2 times in 35 years.  You just have to have lots of tolerance and be document who you talk with and if all else fails take it to your benefits administrator.  I really did not have half the problems that others had because I documented EVERYTHING!   

Thank you! Will do.