Question:
Has anyone ever changed surgeons AFTER getting ins. approval?

I was just recently approved for gastric bypass surgery. I am now wanting to change surgeons in order to be closer to home, it would be a 4 hour drive if I stay w/ my original surgeon, compared to a 1 hour drive if I switch, and my choices in surgeons would be many. Anyway, has anyone ever done this too? If so, did you have any problems, have to start all over, etc.? I just assumed once you got ins. approval that you could choose whoever you wanted for a surgeon. I have spoken w/ others on another site & some have said one would have to start from scratch, risking a possible denial. Is this true? I am at this moment waiting for a call back from the ins. co. on whether they will allow me to do this. TY all so much.    — Cat S. (posted on January 6, 2003)

January 6, 2003
It is probably different with each insurance company/ surgeon. I debated changing to a local surgeon after I had been approved for an out of state surgeon and was told by the surgeons office that I would have to start the approval process over again. If you were approved once then you should be approved again though. That makes sense to me anyway. Good luck!
   — maryburton

January 6, 2003
I was going to change from one physician in the practice to a different one in the same practice so I could get my surgery earlier. I called my ins. co. and they said I would have to go through the whole approval process again since it was a different surgeon. I stuck with my original surgeon. It sounds like you would have to start over.
   — chout1

January 6, 2003
I'll tell you I not only changed surgeons but I changed hospitals also and had no trouble whatsoever having my insurance change over. I just called them and told them what I wanted to do and they told me to choose a surgeon and go and see them and have them submit the paperwork and they would have everything changed over as long as the new surgeon and hospital was in network. It only took me a few weeks to get this done and I didn't have to do any more preparation. Of course my new surgeon did require any pre-op testing so I guess that helped. My surgery is scheduled for April 7th. Hope this helps.
   — Annette S.

January 6, 2003
There are a couple of things to keep in mind: Naturally, make sure that your surgeon/hospital are in the network. Also (because I went through the same thing-changed surgeons, hospital, and a different state!), please make sure that your current surgeon is using the same procedure codes as your former. Everything was looking fine, my ppwk was submitted, however I came up against a wall when the procedure codes were not the same and the Letter of Medical Necessity had to submitted from my new surgeon. This may or may not be your situation, but always good information to know:)
   — A F.

January 6, 2003
Just want to say ty to all who responded. Unfortunately my ins. co. returned my call with bad news. I would have to start all over again. So it looks like it will be a 4 hour trip (several, i'm sure) for me!! Guess I should just be thankful I recieved an approval to begin with!! Thanks again!! :o)
   — Cat S.

January 7, 2003
I switched surgeons, hospitals, and surgery type (switched to RNY from VBG) the day after I received my initial approval. I was concerned about having to go through the process all over again. I was originally told by my new doc's office that I would have to go through the entire approval process again. I thought to myself "no way". I called my insurance carrier and spoke with customer service. They didn't know, so I talked to the precert dept. and on and on until I got to a pre-cert. nurse who was very knowledgable. I got the answer I was looking for. Since I was approved under the standard CPT code for stomach surgery, switched to another in-network doctor, and another in-network hospital, the change was made without having to go back to the pre-cert medical director. All I had to do was provide the new doc's name and hospital name. It was that easy...although at the time, I didn't think it was easy! If you get a negative answer, don't just assume the person you're speaking with has all the answers, keep going up the chain of command. Good luck.
   — lezawomack