Question:
why do we have to gather all info?

I have been reading a WLS book and it is very informative. What I want to know-with no disrespect to surgeons,etc.-is why do WE the patient have to get an extensive portfolio of ourselves and practically sell ourselves for the surgery. I had uterine surgery last year-my first surgery ever-and all I had to do was go for post op tests. Shouldn't it be the surgeon's office that should handle going thru and finding whats best to send to insurer. After all, we are a business client as such and the know the loopholes for approval better than we do and can deal with insurance companies better as that is the business they are in. I am in no way saying that I will not do every last document search and writing folder prep that I need to do for this surgery but feel it should be included in the fee.    — SharonBrown (posted on March 22, 2005)

March 22, 2005
I guess it depends on the office, my surgeons office did everything, told me what I would need to do, before my first visit so that it would make the process go faster. What I think is funny is that I just had to have a hysterectomy and all that doctors office had to do was make one call and it was approved, if only WLS was that simple!!!
   — Haziefrog

March 22, 2005
I didn't have to do anything at all. My surgeon even gave me a model letter of a 'diet history' to be signed by the PCP.
   — vitoria

March 22, 2005
I would imagine that it depends on the surgeon's office. I did not have to do anything but complete the paperwork that my surgeon's office provided (routine paperwork). The office staff did the rest. I did write a letter to the insurance company and emailed a copy to my surgeon to get his opinion. He emailed me back that the letter was great, but that he did not think that I would have a problem getting approved. Sure enough, I was approved 3 days later, without the letter being included. I think it depends on how savvy the surgeon's office is with the insurance companies and how much work they are willing to put into it for the patient. Good luck with obtaining your approval. Nancy
   — MomZombie

March 22, 2005
My surgeon group handled it all. I think this is where a lot of people get so frustrated and run into road blocks. I have seen people on the message board work themselves into a tizzy trying to run around and do it themselves instead of just chilling out and letting the surgeon handle it for them. All I had to do was fill out a packet at the surgeons office that asked about my diet history and medical history then his office took it from there. They also wrote the letter of medical necessity. My pcp didn't even know I had the surgery for several months afterward.
   — Delores S.

March 22, 2005
All we ask of our patients is to fill out some standard office paperwork and we take care of the rest. We also tell our patients not to bother wasting time calling their insurance companies because a lot of the time they don't like talking to patients, plus we can get the info much quicker because we can get right to the nurses.
   — Jessica D

March 22, 2005
I only had to go thru an exetensive interview at the Dr.s office and tell them my medical history and diets I had tried before. They did EVERYTHING else. I only had to try to be patient while waiting for the approval.This is only one reason I reccomend to people to go thru a program that is well established and experienced like Barix. They have the insurance stuff down to a science. I had absolutely no hassles. I have heard others had to go thru hell w/ BCBS, but it was like a dream for me. Sometimes I wonder if people sending their own stuff, letters etc, in addition to the doctors office actually interferes with the process. I mean really, the insurance company is not likely to approve you on your own with our a doctor saying it is medically necessary. And the more paperwork they have to deal with is only going to confuse the situation, especially if you send something that conflicts with what the doctor sent.
   — **willow**

March 23, 2005
How do you expect the surgeon's office to know the "loopholes" for every insurance plan they deal with? I certainly didn't. As an insurance subscriber, it is your responsibility to know what your policy covers. Most times, surgeon's and doctor's offices just don't have the time to research your particular policy and write a letter specific to your plan. You have to learn to be an advocate for yourself! If you want something done right - and the stakes are high - like getting an approval for WLS - wouldn't you rather know YOU did everything that needed to be done to get approved, rather than "hope" the doctor's office got it right? That being said, I got my husband's WLS approved with a BMI less than 40, and I also got my abdominoplasty approved - even though my insurance policy had an exclusion for "panniculectomies and similiar surgeries after weight loss surgery"! Also, we are dealing with having an elective surgery with Weight loss surgery. Your uterine surgery was something where the diagnosis and the surgery were automatically approved based on long term statistical eveidence that shows good outcomes. Keep track of how much time you spend reading your insurance policy, gathering information and so forth, then multiply that by 100 and that might give you an idea of how much time it would take a person to to all that for WLS patients coming to a practice; to do the research for everyone. Learn to be your own best advocate now - it might come in handy down the road!
   — koogy