Insurance questions about tests before surgery ...

Hi everyone! I went to my informational class with Dr. Hong and I loved him right away! He is SO young but he seems very competent and I left there feeling very excited and hopeful. I have Regence BCBS which is supposedly going to cover RNY in 2006 (PEBB). Anyway, I have called them numerous times trying to get some answers and they keep dodging my questions and basically putting me off. They have a 6-month medical workup that is required before you can be approved for surgery. But when I talked to the lady today, she told me that they don't know yet if they will pay for any of the medical testing. Normally they pay 85% if I go to a preferred provider but she is saying they might not even cover anything so I would have to pay 100% of the cost of all the pre-testing. So, has anyone else delt with this? Is this normal? My thought is that they require this testing before surgery ... and if they pay for surgery, shouldn't they also pay for the pre surgery testing? I'm just getting tired of them already! Ha, ha! I know I have a long road ahead of me. Just curious if anyone has any advice? Thanks!!! Deanna

Deanna, I have contacted them also (Public Employee also) and they told me the same thing. Also I asked them about the diet thing...I asked them if one of the programs that they like is Jenny Craig (since they are also giving you a discount if you are on the program) but they said no...I think it is going to be a long hard road but I am determined to get the surgery done also and I am going to fight on. Maybe we should be each others angel huh??? Hope to see you around email me if you like. Sonya

I've got nothin for you on the insurance other than to wish you some good luck. It's really getting pretty absurd that the insurance industry is still trying to dodge this expense - even though they won't hesitate to pay for all of the co-morbidities that result from obesity. It's long past being anything "experimental". Of course they should pay for any testing they require for an approval. How do they feel about accepting testing done prior to January that is within the past six months? (that was paid for by some other insurance). Keep good records of your phone calls, keep calling, get familiar with someone's name so it's not taken as a first time call on your part, get to the bottom of what the policy really is vs. what they want you to accept as their position. Just this month I talked to a person who flat out denied the possibility of something being paid. Two days later I talked to a different person and presented the exact same facts and he put re-processed it to be paid in full. The ones that are the most adament and talk the insurance company line seem like they know the least about things. I think they really don't think whatever it is, is possible, because they don't know any better. Keep at it and I am confident you will get there! I am so glad you liked Dr. Hong. I think he isn't as young as we think he is, but I had the same impression. The information seminar was so much better than the one I went to at Kaiser. Good luck! Patty