Question:
Is it routine to require many tests before a doc will send in for insurance approval?
My doc wants a sleep study to r/o sleep apnea; Esophagogogastrodudendoscopy with a sampling done to test for H. Pylori; abdominal ultrasound to r/o gallstones; EKG and pulmonary function tests; nutrition consult; psych evaluation; and blood work. Is all this necessary for approval? Do any other docs require less? — Elizabeth J. (posted on November 28, 2002)
November 28, 2002
Yes, many Dr's require preop testing. In order to ensure that I was an
appropriate canidate for bariatric surgery, I was required to under go the
following tests: Lab work, Chest X-ray, EKG, GI consult and UGI Endoscopy
and Abdominal ultrasound, Pulmonary consult and Sleep Apnea test,
Psychiatric evaluation, Dietary consult and Echcocardiogram.I was happy to
undergo these tests to prove I was a suitable canidate for the surgery and
to rule out the probabilty of a surprise on the operating table.I want it
to be as safe as possible.I hope your surgery goes smoothly. Leslie
— Leslie E.
November 28, 2002
Depends highly on the surgeon - Mine didn't and I've heard of many others
that didn't either.
— [Deactivated Member]
November 28, 2002
They are not necessary for insurance approval but for clearance for
surgery. I already was on CPAP for sleep apnea so I didn't need a sleep
study. I had the abdominal ultrasound, the EKG as part of a complete
cardiac clearance, chest x-ray, PFT, nutrition and psych consults and blood
work. I was scheduled for an upper GI, but I could not take it due to
exceeding the weight limit for the table...JR
— John Rushton
November 28, 2002
I think a lot depends on your physician and in some cases it depends on
what type of history you have. For example one of the questions I was
asked was if I had ever experienced palpitations. I do(maybe once a month)
this resulted in me having a cardiac stress test. Whether it is required
for insurance approval depends on your carrier.
— Pat B.
November 28, 2002
I believe that it depends on your insurance company's policies, as well as
your surgeon's requirements. Personally, I had to undergo blood work,
Upper GI, chest x-ray, gallbladder ultrasound, cardiac stress test,
pulmonary function test and a psyc eval. All of these tests were required
by my surgeon before he would even submit to my insurance company for
approval. Some of them were also required by my insurance company to
verify my need for surgery, and that I was emotionally prepared for it.
Don't worry, taking all of the tests before your doctor sends in for
approval isn't anything unusual. At least you won't have to run around
trying to squeeze in pre-op appointments before a surgery date. Once you
get approved, you can have your surgery as soon as your surgeon has an
opening. Hope this helped. Take care, and good luck. ~~Kimber~~
— Kimber P.
November 28, 2002
My doctor required the same exact tests yours does. It's not unusual at
all, though there are doctors who require less. But look at it this way,
all those tests mean he's more prepared when he operates on you, and
increases your chance for a successful operation. If you have any
problems, it's better that he know about them beforehand than to find out
about it later!
— sandsonik
November 29, 2002
The tests your doctor has requested are not unusual, but keep in mind that
everyone is different and sometimes it depends on the co-morbs that you are
dealing with in addition to the obesity/morbid obesityand your surgeon.
Once your PCP has done a complete physical and you have the referral or
have had the consult with the surgeon, he will take it from there. If this
requested information regarding tests are for you, then apparently your
doctor feels it is necessary. I wouldn't be too concerned with what
"other docs" require, they each have their own
"criteria" and shouldn't be based on what has been ordered by
some of our doctors. Hope this helps.
— yourdivaness
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