Well this is irritating!

So, Wednesday my insurance company put the status of my surgery authroization up on my profile as "In Process." I've been checking it a couple times a day, still says the same thing. I went out grocery shopping today and come home and hadn't had a chance to check my answering machine. The phone rang and I see it's from my surgeon's office. Woo Hoo! I'm thinking that they got the approval and all that good stuff. Nope, apparently, the insurance wanted a thyroid screening. No problem, I had that done in August. Easy fix, call up my doctor, have her fax it over. But they also need Cardiac or Pulmonary clearance. Umm, what is that? I told the woman on the phone "I don't even know what that is. What exactly is it?" She said to just call my PCM and tell her I need this also faxed to the surgeon's office. Great, so I called my doctor and told the nurse that I need all this. She said she could fax the thyroid thing right away. She had that in my records and that wasn't a problem. But the cardiac/pulmonary thing, yeah, that's gotta go to the doctor who is out of the office today and won't be bac****il Thursday. It's just annoying cause if this is something that she can just fax over today, I'll have lost a few days. And my insurance company is going to cancel the approval as of Tuesday morning and then they'll have to resubmit it all. Just annoying. I guess I shouldn't have assumed this was going to be easy. lol! I leave for The Bahama's tomorrow morning so I won't get to get on top of this until the end of next week or the begining of the week after. Hopefully my doctor will see that she can just fax over clearance and that'll be that. But if I have to wait for an appointment with my doctor to do this, that might add another 3 or 4 weeks onto this. Grrrrrr!!!!!

Those of you with Tricare, what is required for the cardiac/pulmonary clearance? I mean, is it a test? I have no idea what is needed.

For me I don't have tricare, but had to have an EKG and for the pulmonary I had to have a sleep study. Which I have had done anyway for the past 10 years, so that was marked off the list right away. Hope this helps. Best Wishes to you and have a fun trip!!

I am not sure on the pulmonary unless its a pulmonary function test.  The cardiac clearance could be as simple as an EKG and exam with a cardiologist or a diagnostic Cardiac Cath.

I would bet on the EKG and cardiologist though : )  

 

Hang in there! You will make it (with a clean bill of health to boot!)

 I don't have Tricare either.  But for my insurance to be approved I had to see a cardiologist and a pulmonary doctor.  The cardiologist clearing is a Ekg, and a stress test.  Pulmonary doctor he did a check up on me and scheduled me to come in for a breathing test.  He was also the one who said I wouldn't need a sleep study.  Hope the helps.

Hey there!

Oh I was so hoping to see an approval as your next message.  As you know I have tricare, and really all I did was a bunch of lab work (like 10 tubes) an EKG and a chest xray.   The EKG and Chest xray took all of maybe 20 mins if that.  I did it at the hospital that I had my surgery in.

I hope you can get everything done and resubmitted in a timely manner.  Enjoy your trip as well!

Its easy, they want to make sure you heart is strong enough. And you dont have any problems with you lungs. It depends on what your doctor wants to see and what tricare is wanting to know, that will depend on what test they do. For the cardiac test, more then likely a cardica ultrasounds/EKG or ECG. Its not anything, dont worry about it. Take a breath and relax, everything will be okay and it will happen in time. I have Tricare, if you have any questions about them let me know.

I'm tricare..In my case.. no psych, no 6 month diet, just labs..Maybe it depends on your health status??

Petra

Hi,

I had o get both as arequirement or the surgery.  The Pulmonary clearance required me to see a plmonary specialist and go through an extensive series of respiratory/breathing tests.  Took about an hour or so and that was it.  For the cariac clearance I saw cardiologist, had an echocardiogram, ekg and a stress test.  They are trying to determine if you are able to withstand the surgery and anesthesia.

I wonder why all of the surgeon's offices don't give you a check list of items that need to be completed before submission for pre-authorization..

I had to do the following:

Complete an on-line WLS educational video and test.

Meet with a nutritionist to start behaviour modification protocol

Sleep study

Psychiatric evaluation

Cardiac stress test

Have all my annual screenings done- colonoscopy, mammogram and complete physical from my regular physician and have my PCP fax over his written letter of endorsement of the surgery and commit to following me up post-op.

Once the checklist was done and I completed the 3 months of behavior modification, then they submitted for pre-authorization and surgery was scheduled.

This seems like it would save a lot of "do-overs" and misunderstandings regarding pre-op requirements.