Question about insurance

We have Optimum Choice Insurance (which does have a stipulation that gastric bypass surgery can be done for the morbidly obese *I hate those two words*) and I just called them to find out what they require. All they said they need is a pre-auth from the doctor and a psych evaluation. Now, I was under the impression that so much counseling was needed and meeting with a nutritionalist was mandatory. I called twice, just to make sure, but got the same girl both times, so then I felt like a goofball ;). So, is it the surgeon that requires the additional things? I think they are definately a good idea, so I'm not sure why insurance says it is not required. And thanks, btw, to everyone *****sponded to my first thread! The more I think about having this surgery done, the more excited I get, having battled weight my entire life. I can't imagine what it would feel like to look like a thinner, healthier person.

Hi. I have Blue Cross Blue Shield (federal). I'm unsure as to what they cover, but you are right.. I did have to do a series of blood tests, meet with a Nutritionist, I had to do a sleep study, which I just received my bill for . I would like to suggest, get those tests done ASAP. I waited until a month before my surgery and I became very overwhelmed. My guess is it is the Surgeon *****quires it. I had to pay for my Nutrition class whi*****luded(s) 3 sessions. first one being in a class situation, second being a one on one before the surgery.. The third, i have in Feb. I've always hated that word Obese, and when they put the Morbidly in front of it it makes me even hate it more.

It is likely that once you meet with the surgeon, he will then tell you what Optimum Choice will require. The MDIPA/MAMSI/Optimum Choice/Alliance insurances are with the same company but can have different requirements. In addtion, The MDIPA, etc. has been bought out by United Healthcare and it is likely that they will make some changes. A referral to a psychiatrist is generally required for the psych eval and it is your primary care doc who makes the referral. Meeting with a nutrionist is important and I don't recall one insurance that doesn't require a nutritionist consultation. Your primary doc will need to do a physical and at that time other tests may be ordered. The surgeon may also request other tests. For example, often a person can have a sleep study for sleep apnea. When my surgeon suggested it, I was able to convince him that I was not a candidate for a test when I had no indicators of sleep apnea. Bottom line, work with your surgeon and primary care to meet the requirements.

I have MAMSI/Optimium Choice and I went to my insurance company first too, but I got it in writing. I emailed them with my policy/member #'s and asked specifically if the surgery was covered. They can't guarantee services just by calling the customer service #, so I would suggest writing them and getting a written response. My response was simply their exclusion from the manual and under my policy, I was allowed a "group" consultation with a bariatric surgeon without pre-authorization and from there, they required 6 consecutive months of a physician supervised weight loss program, medical documentation of 3 comorbidities associated with obesity and the psych eval. If you go to the companies website, they should provide you with an email address members can use for questions. Be specific in giving your member/plan/policy #'s and ask for their exclusions, if any, for gastric bypass or weight loss surgery. Take a copy of their response to your consult so that everyone know's what is required. They should answer within 24 hours. Good Luck!

Oh, and to answer your other question, yes, often times the surgeon does have requirements such as counseling and/or a nutritional calss. But those are things that can be as little as 20 minute visits, so it's not like it would delay the procedure or anything.