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I have started the process to have the lap band surgery and am a little worried about the insurance coverage.  They say that I have the coverage but they won't pre approve the surgery!  I have to have the surgery and then they will tell me if it was covered.  Has anyone else experienced this?  Is there anything that i can do to be pre approved?  Thanks in advance for your help.  Ash

Hi.  I haven't exactly experienced that, but my surgeon's office said that since I have a BMI over 50 that I am pre-approved....I don't need prior approval..  I asked about that and she said that after the surgery they'll  just bill my insurance (BCBS).  I have contacted BCBS and they verified that I have coverage and the codes for the procedure are covered.   So I am hoping that there is no glitch I fall into and have to pay for it all out of pocket. Good luck to you! Gwen

Gwen -  If you're worried about it, call your insurance company and ask for a list of requirements to be mailed to you.  That way you have that proof that you don't need pre-approval in writing and if anything happens where you end up with a bill to pay, you've got some recourse and something to fight with afteward.   Pam

Well, I don't know what insurance you have, but I know that my primary insurance didn't cover anything, but my 2nd insurance said the same as yours did...they did not do "pre-approvals" but would determine coverage after the surgery.... I have Medicare for my 2nd insurance and my doctor was familiar with dealing with them so they knew what needed to be done to make sure it was covered... so I would suggest talking with your surgeons office to make sure that they know what requirements need to be met for you to be covered....

I know I made a lot of phone calls between the surgeons office and the insurance company, so I wish you a lot of luck dealing with all of that.. I know how trying it can all be.....  Keep us posted on your progress....

 

Good Luck,

 

Who is "they" --- who told you that your insurance covers the surgery but won't pre-approve?  Was it your insurance company specifically or the insurance clerk at your surgeon's office?   I would call your insurance company (the number on the back of your card) and ask them specifically what you have to do to qualify for surgey.  There is a list of things you need to do beforehand.  Get that list in writing - ask for a letter to be mailed to you.  Then use that letter as your checklist.  Once you fulfill all of those requirements then your surgeon's office will approve you for surgery.   Your surgeon's office is going to be very careful to make sure they have all the requirements fulfilled too.  Because they're going to be worried about getting paid.  They know that if the insurance company won't pay that bill then they are going to have to come after you for it --- and the likelihood that doctors get paid when insurance denies is pretty slim.  So they are going to get all their ducks in a row before they set a date for you. I have BCBS and was not pre-approved by insurance.  I just used my letter as a checklist and when everything was done I was scheduled.  In fact, within a few hours after that last item on the list was done I had a surgery date.  No waiting 30-60 days for the insurance company to make up their mind. Pam

Pam,  I was just reading and I see we have the same surgeon! Was your surgery good.  My date is May 6th and I am scared. I was looking to find someone who went to the same hospital as me and had the same surgeon. Do you have any tips for me? Thank you Angie

Hi Angie - Dr Farhan is a great surgeon.  He was just named as the head of the bariatric center as well as head of the trauma unit at Hurley.  He's been with the bariatric program since the beginning and is very experienced.  However --- don't expect to be best friends with him.  LOL!  I hear of so many people here on OH who say how much they love their surgeon and how they see him/her everytime they go for a follow up appointment or he/she recognizes them in the hallway at the office --- or whatever.  At Hurley you deal with the staff for your follow up care.  Nutritionists, nurses and nurse practionists will deal with whatever you need.  I met with Dr. Farhan before my surgery for a short meet-n-greet (he wasn't my original surgeon choice, I was going to go with Obeid).  Then I never saw him again - not before surgery at the hospital, not during my hospital stay, not at follow up appointments.  But that's fine with me.  He did his job when he performed the surgery and that's what I want him to be the expert at.  Then he leaves the rest of his staff to do their jobs -- which they are experts at.  If you haven't been to the support groups at Hurley yet, I'd highly suggest checking them out.  Also I'm a part of the Flint Area Support Group - we meet on the 3rd Monday of the month at Hurley Health and Fitness (classroom A) at 5:30.  If you can make it, we'd love to have you there.  It'd give you a chance to pick our brains about any last minute questions you have.  Shoot me a PM if you want more information. You'll do great!  Holler if you need anything. Pam

Thanks for everyones good advice!  I will keep you posted on how things are going!