How long from 1st consult with surgeon & actual surgery for gastric bypass surgery?
I have been down this road before, last yr I went to a consultation with a PA to start the process of having wls, I was all for it but due to some issues I could not proceed...... Well this yr my husbands insurance has changed, we now have bcbs of south carolina, I went to a wls seminar & had a phone consult with the PA now I have a face to face consult set up with the actual surgeon on Nov'19...... I am super excited but I have searched & searched the internet to find out if my insurance will cover this or not & I haven't been able to come up with anything. So I called them & I spoke with a representative, he told me that the surgery will need precertification (not to sure what that means) & depending on the way that the surgeons office codes things the surgery may or may not be covered..... I am lost! I asked if he can tell me what there criteria is in order for a patient to be approved for the surgery, he just said that there really isn't any criteria, it all depends on the surgeon & how they code things.... What??? Usually insurances have all sorts of criteria that have to be met by the patient 1st, dont they? He said that I dont need a refferal to see the surgeon, I asked if I needed one for the dietician or psychologist, he said that they dont require for me to see either (tho the surgeon that I am going to be going with does)...... Can anyone give me any insight? I am going to be going with the Reading hospital in PA, my consultation will be with Dr.ku, & they do require for every patient to see a dietician & a psychologist as well as going through a weight loss program prior to surgery.... So if my insurance doesn't require any of this & my insurance approves the surgery, how long will I be waiting to get a surgery date? Any insight, personal experiences, would be greatly appreciated......
Wow...sounds like they are confused. Precert sounds like a pre auth. Ask the coder at the office to call your insurance company and ask them how it should be coded to be a covered benefit for you that way you're good to go. As for surgery time...it depends on your surgeons schedule. Typically you have like 60-90 days from the approval to have surgery. I went from consult surgery in about 3 months. In that time I had my pre op stuff done like abdominal ultrasound (to check gallbladder & liver), ekg, pulmonary clearance, psych eval, nutritionist visit. Once the stuff was sent to my insurance I had approval in 3 business days and had surgery 3 weeks after that. Good luck!
__________________
Kristy (33) & Adam (36) & DDs Alice Kay & Amanda Kay Founding WLS DIVA - RNY 8/3/04
To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
Thank you so much for your reply..... I thought they were confused too & in turn they had me all confused. After searching & searching I went on the web site that was printed behind my insurance card & I send the insurance company an e mail. I asked if the gastric bypass would be covered & what were the requirements/criteria that I would have to meet for the surgery to be covered, they send me an e mail back telling me that the only requirement they ask for is that the surgery be pre certified. I called my patient advocate & spoke to her & she told me that the pre cert process takes place after all of the tests/labs, visit with nutritionist & visit with the psychiatrist takes place, she said they will send the insurance all of this info along with a letter of recomendation for the surgery from the surgeon & then its in the insurance hands..... Then she tells me that my insurance company is not one of the easier ones to deal with, so I am just hoping & praying that my bmi alone which is like 52, will really stick out to them & they pre cert the surgery & eventually approve it.
Hmmm...they seem really confused! I had my RNY at a Bariatric Center of Excellence and they require quite a few things before you can even get in for a consult. I had to do an intake packet which seemed like I"d never get through filling it out. Once that was turned in, I had to do the dietician appointments, psych evals, and physical (as required by them and my insurance company) before I could even get in for a 1st consult. Once I got in for my consult, my Dr. made me loose 10 lbs on my own (as he does for all his patients to see how serious you are about the surgery and if you have motivation to stick with the program). Once that happened, then the letter was sent off to the insurance comapny and I just had to wait for my approval. From intake packet to sugery day it was about 10 months.
How long from 1st consult with surgeon & actual surgery for gastric bypass surgery? 
