Approved? - ThinnerTimes

Withacy · 07-05-2008, 04:44 PM

Well, I was told to wait for the letter from the insurance company to see if I was approved. I got a letter today, but it just might be approval to see the surgeon. I can't really tell - which is pretty bad, since I've spent the last 10 years as a federal bureaucrat working with federal regulations over Medicare and Medicaid. Talk about obscure letters!

Well, the endocrinologist who has been working as my gatekeeper for the last YEAR told me to wait for the letter, then call his office. So I got a letter, I guess I call on Monday. I really hope this is what I'm waiting for.

RebeccaNV · 07-05-2008, 04:47 PM

I hope that it's your approval.

eli_far77 · 07-05-2008, 05:14 PM

Well, not sure what type of insurance you have but I first had to get an approval from my insurance (I had HMO) for a consultation with the surgeon. After that the surgeon gave me a packet of papers to fill out and they submitted everything (lab results, etc.) to the insurance company for surgery approval. Did you take any of these steps yet?

BabyNicole · 07-05-2008, 05:48 PM

I'd call up the insurance company to verify!

Withacy · 07-05-2008, 06:48 PM

I have an HMO (Kaiser). Their processes for approval is very involved. They use an Endocrinologist as a sort of gatekeeper. My PCP referred me to him. He gave me a lot of paperwork, did blood work & a history. Then he sent me off to have 8 Nut visits and 20 psych visits and an MMPI. Once both of them had signed off on it, it went back to the endocrinologists who sent in his approval letter with the other letters to the HMO.

He told me that I'd get a letter - probably an approval - in 7 - 14 days (his nurse said it could be up to a month, but the HMO's letter was dated exactly 1 week after he sent in the letters & his approval). Then I was to call his office, they'd set up the heart, lung, gallstone & upper GI tests, then the surgeon.

I'm confused because the letter has 2 "services" on it, both from the surgeon (I recognize the name from some previous materials), and one of those services is clearly an office visit (the CPT starts with 99). The other CPT starts with a "2", but it's been so long since I did claims....

I guess I'm just confused because the format isn't what I expected. Also, this is strange because I know from this group that a lot of times the surgeon is the one who sets up the tests, while the endocrinologists made it sound like his office did that. You'd think that after 25 years in the health insurance/federal oversight arena I wouldn't have expected something like "Dear Ms. Withacy - you are approved for RNY. Good luck and have a nice day."

I will call on Monday, but I'm one of those people who wants to know NOW! (Of course this came in the mail on a Saturday.) I mean, it's been a YEAR already...I just want to know everything for sure. Is that too much to ask?