Surgery at U of MN? Insurance issue question

I will be having my surgery at U of MN Fairview by Dr. Leslie.

They are assuming that I need 6 months structured weight loss because BCBS usually requires it. However, it appears my type of BCBS (Anthem) does not require it at all. A co-worker recently had surgery and it was not required. But I am being treated with skepticism, which I understand.

The insurance company won't give me the information so I called their surgery/insurance coordinator on Wednesday and am still waiting for a call back. I've left her two messages on what I understand it to be and asked that she call me so I at least know she's on the case. I feel like she should have called me back by now even just to let me know she is looking into it.

Am i just being way impatient? Has anyone had a similar experience at U of MN?

This info is the difference between me having my surgery in November versus March so is quite important for me to have and plan for. Regardless I'm doing the structured weight loss thing anyway just in case. 

Thanks!
Anna

I feel for ya.  I had the same problem still do.   Took them 6 calls and 7 days to remake an appointment becuse the doctor decide at the las min to go out of town.


Amelia

I have BCBS-NE and do not have to have a 6 month structured WL program. I have called many times to see if someone will give me a different answer and its always the same.

I am trying to just get all of my requirements in that I know of. So I have all my psych eval appointments set up. I will be finished with them on Oct. 16. I'm just hoping that after my successful (hopefully) completion of the psych eval, I will be able to have them send everything in for approval.

I try to let things go that aren't in my control, but this is a huge thing. I mentioned it to one of the nurse coordinators and she said, yeah, it can take her a while to get back to you.

This is a huge flaw in the system. My friend went to St. Joe's and was so happy with them. But I'm trying to get my surgery done this year (I have paid my out-of-pocket for the insurance) and St. Joe's would take me into next year.

I know things could be worse but aaaaaaaaaaaaaaaaaaargh, I'm frustrated.

Thanks so much for listening to me vent.

www.anthem.com/ca/medicalpolicies/policies/mp_pw_a053317.htm



I also have Anthem, and had my surgery at the U of M.  Fnd the clinical guidelines for WLS at the lilnk above; print it out, and teke it to the clinic.  That's what I did, and had no trouble.



My surgery was with Dr. Ikramuddin, and he requires 3 months of dietary consults,  although Anthem does not specify a number of visits.



Good Luck!

Edited to add that my insurance is Anthem of California-- don't know if that makes a difference in the requirements.

Thank you, PMarie! You are my hero! The problem is I have no clue what state my Anthem is considered in. When I go to the doctor, they always say it's out of state. I think that my company might just be large enough to have our own policy, I'm not sure. We have tens of thousands of employees.
How were you able to find that document? I've spent hours on Anthem and wasn't able to find anything.
I may just give them that document. It sounds exactly what I understand my plan to be. Again, you are AWESOME!

I have BCBSMN and had surgery at the U of M as well. I have to say I ran into the same issue with them. When I went there, I had already started the whole WLS process so I had completed all of my insurance requirements by the time I went to the U of M to meet with the surgeon. I had a really hard time with the nurses and what not listening to me. they kept telling me that I needed to have at least 6 visits with a dietician. before I even went to this clinic, I had done my 6 months of medically supervised diet (which was required by my insurance****pt telling them that I didn't need them, they kept telling me that by insurance required it. I finally did what someone else mentioned, printed out my policy and brought it in. My first appt with Dr. Ikramuddin was on jan 28, 2008 and I had surgery on April 2 (it postponed was originally supposed to be in march). I feel like the only reason it took longer than it should have, is because they weren't listening to me and kept fighting me telling me that I needed the dietician visits. Finally, i just told them to submit my info and see what happens. Even then the nurse kept telling me that I wouldn't get approved because I didn't have the dietician visits etc etc etc. Once she submitted I was approved right away. I don't understand why it is so hard for them to believe that some of their patients have their stuff together and come in prepared. Good Luck though, hang in there it can be frustating, but don't give up and don't let them tell you something that you know isn't true about YOUR insurance.

~Rose

Boy, Rose, I guess I'm right at the beginning of that aggravation. I"m frustrated because they say, call Desi, but she doesn't call back. Does she ever call back?!?
I'm glad you finally got your surgery. I really want to have it done this year so I'm afraid I might have to get quite pushy with them.

Yay! I found the requirements for my insurance on the Anthem website. Turns out my insurance is in OH, for some reason. (Seems to be a secret, my co-woker who had surgery said they "accidentally" let it slip one time them called her. Why is this info so hard to find? Sheesh!)

I'm going to mail them along with a letter to Desi. Still aggravated about the lack of a return phone call. I guess I will have to look at this as a growth opportunity for my impatience.

I just wonder, does the clinic know people are getting frustrated with them because of lack of return phone calls in this area? It doesn't make the clinic sound as trustworthy when you can't get help when you need it.