Question:
I am switching surgeons AFFTER insurance approval. HELP......

I have seen a roux-n-y surgeon and received "Approval for medical necessity" from our insurance based on this surgeon. I found out that both the surgeon and hospital is out of our PPO network after I was approved. Now I want to "switch" to a surgeon and hospital that is part of our PPO network. The insurance company tells me that I will have to go through the approval process all over again because I am changing surgeons. The office staff at the "new" PPO network surgeon's office claims that the insurance representative is INCORRECT and that I DO NOT have to be REAPPROVED. They claim this happens all the time and I should let their insurance specialist deal with my insurance provider. I don't know who to believe at this point. But, I'm sure in the end I will be the one left holding the "bag" since I cannot get an accurate answer. Has anyone been in this situation. If so please help as I don't want to be denied benifits because I was "Approved with surgeon A" and "Not Approved with surgeon B", but "Approved for the procedure". Sticky situation I got myself into. Help..... Sincerely, Bill in Ohio    — WILLIAM G. (posted on September 14, 2000)

September 14, 2000
Bill, I switched surgeons after receiving approval with my first surgeon. I also switched procedures going from an open RNY to a lap RNY. I had to submit for reapproval with my insurance company. Fortunately my second surgeon went ahead and scheduled my surgery dates before my new insurance approval came in (since he was certain I would get reapproved.). I tried to speed things along by contacting my benefits manager at work and asking her to use her insurance contacts to expedite the 2nd approval because I had already been approved once. I believe the insurance specialist at your surgeon's office probably knows what he/she is doing - you may want to let them work it for a while and then follow up with your insurance company to make sure they are in agreement. Most surgeons won't perform the surgery until they know for sure your insurance company is going to pay. But I can understand why you would be nervous - insurance companies can be a pain. My recommendation is to let the insurance specialist work it, then follow up with your insurance company to make sure they have everything they need - if things continue to be uncertain ask your benefits manager at work to get involved and straighten it out for you - that's what they are there for and they have access to insurance contacts we dont. BTW I never told my benefits manager what type of surgery I was having - but once she got involved I had an email from her insurance contact within two days providing me with my new authorization numbers. Best wishes to you.
   — Jennifer L.