Should I be doing something else? - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

DenMomLT · 10-21-2009, 03:03 PM

When I began researching WLS, I discovered that my Aetna PPO through work did not cover bariatric surgery any way, shape or form. However, I found that the Aetna HMO offered by my employer did. So, I waited until open enrollment, verified that they do cover it, and hopped on board the HMO.

My PCP agreed that I was a good candidate for WLS and put in a referral to a bariatric surgeon. I went to the educational seminar, met with the nurse practitioner for a consult, have done all the requested blood work, psych consult, EKG, gall bladder ultrasound. I've provided all of my PCP records, test results, documentation of 3 years of weight loss attempts with the PCP. I see the dietician/nutritionist today and then have a consult with the nurse practitioner again on November 20. Other than having a blood nicotene test to prove that I've quit smoking (proud to report that I'm smoke-free for 23 days!), I've done everything I've been asked.

Should I be doing something else? I've read posts about contacting insurance and having a "client manager" or something of the sort assigned to an individual case, or finding out exactly what the insurance requires, etc. I've hesitated in contacting insurance for fear that they would make a note in my file about inquiring or something...I'm being silly I know. I'm not sure what the next step is. I'm guessing that once I see the nurse practitioner again in November and we make sure that all my ducks are in a row documentation wise, it'll be submitted to insurance. Does this sound right?

Thanks for your input! This site ROX!!!

Chrissie23 · 10-21-2009, 03:10 PM

I never had to do any guesswork... the hospital/people I'm going through tells you and outlines the steps you have to take. I had a 6 month diet I had to do (required by my insurance) and whoever I met for the month would tell me who to see the following month etc etc. I would ask the nurse practitioner what else you need/have to do... That's one thing I love about where I'm having it done, the bariatric floor has their system down PAT! I wouldn't worry as long as you're completing what your insurance requires!

poet_kelly · 10-21-2009, 05:18 PM

Well, the surgeon's office probably knows what your insurance company requires because they probably deal with them all the time. Nonetheless, yeah, I would call the insurance company myself and verify. If you miss something important and submit for approval, you'll get denied, of course. Best to keep on top of it.

By the way, if you call and inquire, I don't know if they make a note of that or not. But what if they do? You have every right to ask questions about the benefits you are paying for!

Kelly