Insurance Approval workaround

Hi, my insurance doesn't cover bariatric surgery. I have an experienced doctor who is willing to do the surgery at the same time as a hiatal hernia repair and list it as such without mentioning she's doing the gastric bypass while she's in there in the general vicinity of my stomach... so to speak. Anyone had this experience?

My concern is other than the competency of the surgeon and the moral/ethical delimma, what other concerns should I consider?

Insurance fraud. Your doctor is crossing a legal line and putting you and his- or herself at risk for a lot of legal trouble.

Even if you and your doctor are willing to risk this, many insurance companies do something called a post-claims service review for claims over a certain dollar amount. That review would likely include your surgical report. I don't see that ending well.

ETA: I see you list your surgery date in 2002 as RnY. Are you seeking a revision or is this a windup?

Sounds like insurance fraud to me.

What you doc is suggesting is insurance fraud.

If you agree to that -- you would be part of the fraud.

In the future - you need to list previous surgeries - how would you explain that? To anyone? What if you have complications?

IN addition to the whole issue of it being fraud, if you had any complications how would you explain that with your insurance? You wouldn't be covered.

An option which you could do that is legal, would be inform ins co that you will also be having a bypass and have the hospital charge you for the extra OR time, the hospital stay should be roughly the same in length. So no faud if informed.

If you speak with the hospital they can probably make it a very affordable cost and have your surgeon "go to bat" for you also since you already have a medical condition that needs addressing. And if complications arise, pre existing conditions do not apply and they shouldnt deny you if you paid for a procedure they exclude, they will probably try but fight. Emergency is an emergency.

I cant promise anything but it is an option to look into so you are not commiting fraud.

Like others have said this would be insurance fraud AND you just put it on a public forum . . .

See if you can self pay for the weight loss surgery portion of the surgery while the hiatal hernia repair work is happening... so you would negotiate a price for the surgeon's fees, the surgery itself but utilize the hospital fees, anesthesiologist fees, etc. would be covered by insurance for the other surgery assuming the other procedure is approved.

I am hoping that the Dr just offered to do your WLS without billing you for her fee. Your insurance company will get the hospital bill which will include, amount other things, the pathology report of what ever is removed from your body. If this is the case then you should call your insurance and let them know that you are having a non covered procedure along with your covered hernia surgery.

If the Dr is performing the hernia surgery just to get partial payment from your insurance company you should think long and hard about her over all ethics before letting her near you with a scalpel.

Thank you for your replies. This has had me perplexed and I'm wondering if I have all the information. I really need to ask more questions. It's inconceivable to me that an established doctor would put their practice in such jeopardy since I agree with what's been said.

And, if it happens to be the case, if the fraud didn't stop me(it does) then the risk of complications and not having future issues covered definitely does!

Thanks also for those who provided ideas on alternative approaches.