Question:
My insurance approved me for surgery, but nothing else!

They denied my Nutritional eval. Psych. eval, bloodwork, pre-op tests, but they approved the surgery and my doctors consult? Does this make any sense? They are the ones that require the psych. and nutrition evals???? Please help anyone!!    — Heidi S. (posted on October 31, 2003)

October 31, 2003
I had to pay all the pre stuff myself. it came to about 500.00 they never paid the Nutritional eval or nutritional follow up. no psych evals. they did pay the pre-op, the surgery. and all follow up. now they have approved the trimming of the extra skin but not the abd plasty. which is common too.
   — Joan W.

October 31, 2003
I have known a lot of people who had to pay for a nutritionist, etc. I say find out how much you will need to save up and go for it! The surgery being paid for will save you a ton! CONGRATS!
   — Saxbyd

October 31, 2003
I don't know what kind of insurance you have, but my BC/BS said that sometimes they don't approve the pre-op until AFTER they have paid for the surgery, then they go back and pay it. Evidently they wait to be sure the surgery is actually needed before they pay for finding that out.
   — CAMFR

November 1, 2003
My insurance company is tightening up on paying for the psych evals and other tests the surgeon may order, since the insurance company DOES NOT require these tests and the surgeon does. I would wait until after surgery, let the dust settle and appeal anything that wasn't covered, but you think should be.
   — koogy

November 1, 2003
Insurance companies are ridiculous, but if I were you I would be VERY thankful that they are covering the surgery, hospital etc. My insurance company paid for NOTHING, so be grateful and shell out the cash or credit to pay for the psych. eval and bloodwork, whatever. A couple hundred bucks is a small price to pay, believe me. I'll be paying off my surgery for the next few years still! Good luck.
   — KelBurt

November 1, 2003
I would definitely appeal the psych eval since they required it. Also the bloodwork and pre-op tests as they are required for surgery. My recommendation for appealing is based on assuming there isn't somehting in your policy that excludes coverage for those types of things. Did they flat out say they are not covered? I find it quite strange and certainly would be questioning it.
   — zoedogcbr

November 2, 2003
My insurance paid for my consult with the surgeon but did not cover my visit with my PCP (primary care physcian) (I have Health America HMO) The visit with the PCP was required by them in order to provide them with a supervised visit for 3 months. I contacted my PCP's office and talked to them about it. There are certain codes the doctors have to use when billing your insurance company. The doctor may have to correct the codes they are using to bill with... this is why my visit ended up being denied. After my PCP re-submitted correctly... they ended up covering it. Worth the phone call to see if it will help.
   — Christine S.