My ins co won't disclose pre-reqs to me

 I called my insurance company to find out what the requirements were to qualify for WLS. I had the codes for the dx and procedures. Both the rep and her supervisor told me that they couldn't tell me, that a different team handles that, and that this team is strictly internal and so I cannot speak with them. They told me I must deal with my doctor's office instead.  

1) If the doc's office can get the requirements, why can't I?

2) Is it even legal to refuse to disclose the requirements to me?

My other issue is, it's now my enrollment period and I can choose a different company, but without knowing the requirements that each of these insurance companies require, how would I know which to pick????

Thanks! 

You might try a google search.  I know Aetna has it's Coverage Policy Bulletin regarding bariatric surgery online, and others have posted it around OH.

Remember, though, that it's up to each employer to decide whether or not to cover bariatric surgery.  The insurance company just writes the policy that the employer wants.

I know it's frustrating.  I've worked in health insurance for 18 years and I'm confused and frustrated too!  Hang in there.  Hopefully we can all help each other.

 Thanks for your response Beth. I tell you, trying to find all this info is like searching for the proverbial needle in a hay stack. 

There's probably some sort of insurance board in your state that will advise you on exactly what they have to tell you and take care of the problem for you if they don't do it.

If you find out let us know, I am also in the same boat.  I have contacted my insurance company and recieved the same answer.  I had to put it back in the doctor's hands and see what happens.  It is hard to deal with this part of it.  Hope it works out well for you. 

I don't understand why they won't disclose the requirements to you. When I called to check what my policy covered they went over it in detail over the phone and then mailed out a hard copy.

 I am having the same problem.  I called the insurance company to make sure of the pre op requirements.  The docs office told me I didn't have to do a supervised diet and that just doesn't sound right, so I wanted to confirm it with the insurance company.  I was told the same thing you were.  They only tell the doctor.  I can't talk to the people that have the requirement info.  

I wonder what the big secret is?

 @mistyshadows:  you know, the thing that really frustrates me is that one surgeon's office told me that my insurance company requires a BMI>40 for a minimum of 5 years. The other surgeon's office told me that they don't. 

They really don't make this easy, do they?

 Guess what!  I decided to mess around on the insurance co's website.  I clicked on the Provider tab, then clicked on Manual and Policies, Surgeries.  Eureka!!!  There it was in black and white.  See if you might find something similar on your insurance co's website.

Which ins co do you have? We might be able to do a few searches and find their policies on line.