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BrightValley

PLEASE Verify EVERYTHING Directly with your Insurance! N

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I learned a valuable lesson today--and I'm celebrating.

I have Medicare with a supplemental AARP plan through United. All my pre-op testing and necessary requirements have been met and yesterday I went to the first 1:1 meeting with my NUT after the General Nutrition Seminar. She looked at my paperwork and said all that remained was 4 additional 1:1 meetings with her spaced one month apart, so the last would take place the first week in Nov. After that, she said, I would meet with the surgeon and surgery would probably take place sometime in Nov. She added that United required the six months of NUT classes as a prerequisite for surgery. She is my contact person throughout the program.

I started thinking about it today and called United directly to verify. The agent stated they abide by Medicare guidelines and no Nutrition guidelines beyond the general seminar were required at all. Hmmm...I called back and another agent repeated the same thing. In a flash I'm on the phone to the Hospital Bariatric Coordinator. She assures me I am mistaken and that United ALWAYS requires six months of NUT meetings, then asks me if I can obtain it from United in writing that I do not need those classes. So I push back as nicely as I can, giving her my Medicare and United policy numbers, assuring her that, as a provider, her dealings with United would totally clear things up. She isn't very happy but says she will call them.

Two hours later she returns my call and--wait for it--there are no six months of NUT classes required by United. The hospital program requires a minimum of two so my final one will be Aug 2nd. Since all my pre surgery requirements are completed I will meet with the surgeon and she estimated surgery will take place in late Aug. or early Sept.

Please, everybody call your insurance PERSONALLY to verify everything your policy requires and covers. The Bariatric coordinator did not say how this misunderstanding happened and I didn't ask her but Aug/Sept is a far cry from Dec. for my circumstances.

I just learned being proactive means more than asking the right questions through a complex process like this one. It means asking the right questions through the right SOURCE...I wanted to share this experience with all the wonderful people on this forum!  

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Insurance coordinators should know better than to generalize coverage by the carrier. I had United through my self-insured employer when I had my surgery. All that they required, per my employer's contract with them, was a BMI of 40 or a BMI of 35 with comorbidities.

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