insurance question

[Guest guest]

hi all i'm just starting this process and i went to my family doc so

he could recommend a good surgeon and to talk things over with him, he

thinks I am a great canidate for the surgery. Anyway I paid my copay

like always and got an eob from my insurance that said it wouldn't pay

for that office visit because it isn't a covered kind of deal. I know

my doc put the diagnosis as obesity. I am wondering if this happened

to anyone else and they were able to get their insurance company to

pay for the surgery. I am feeling very discouraged and I am just

startign Ugggh! So any feedback on this situation would be greatly

appreciated. I thought perhaps they wouldn't cover it because they

don't want me to start the process of having the surgery and maybe

they think this would make me think it wasn't possible. Thanks a

bunch! Laurie in PA

[Guest guest]

OK now this MIGHT be one of those subtleties that I've experienced

with my PCP before. When I was heavy I would have to come in and have

my blood pressure and other things checked every quarter. Obviously

if I had any questions, wanted to talk about wls, diabetes, etc. etc.

it was no problem. I mean a visit is a visit right?

Along comes surgery and now I'm down to only being required to visit

her once a year. If I have any questions or concerns outside of that

time frame it would have to be a separate appointment. Obviously if

my question/concern involves a pain in my ____ or even a blemish on

my _____ then we've got some potentially physical ailment there we

can toss a diagnoses code down for.

Your PCP tossed down obesity. It's possible your insurance company

doesn't go for that from a PCP and might only deal with that from a

specialist. It's definitely worth checking into. My PCP resorted to

giving me a physical the last time I had a non-kosher diagnosable

issue appointment. That's only good once a year too though.

I can see where this would concern you with the surgery. I'm sure

everyone here would agree that you should get approval (or denial for

that matter) for weight loss surgery (specifically) from your

insurance company IN WRITING. That way neither you, they, your

surgeon, etc. are mistaken in what's going on.

Mike in GR

>

> hi all i'm just starting this process and i went to my family doc

so

> he could recommend a good surgeon and to talk things over with him,

he

> thinks I am a great canidate for the surgery. Anyway I paid my

copay

> like always and got an eob from my insurance that said it wouldn't

pay

> for that office visit because it isn't a covered kind of deal. I

know

> my doc put the diagnosis as obesity. I am wondering if this

happened

> to anyone else and they were able to get their insurance company to

> pay for the surgery. I am feeling very discouraged and I am just

> startign Ugggh! So any feedback on this situation would be greatly

> appreciated. I thought perhaps they wouldn't cover it because they

> don't want me to start the process of having the surgery and maybe

> they think this would make me think it wasn't possible. Thanks a

> bunch! Laurie in PA

>

[Guest guest]

thanks for the input i have some research to do!

[Guest guest]

My insurance won't pay anything if the diagnosis is obesity. My doctor

has to put it under something else. Well my old insurance. I have new

insurance now. Not sure how it'll work; but I think it covers

WLS...nice to know since I was selfpay! LOL

W

380/264/160

itsmelaur7269 wrote:

> hi all i'm just starting this process and i went to my family doc so

> he could recommend a good surgeon and to talk things over with him, he

> thinks I am a great canidate for the surgery. Anyway I paid my copay

> like always and got an eob from my insurance that said it wouldn't pay

> for that office visit because it isn't a covered kind of deal. I know

> my doc put the diagnosis as obesity. I am wondering if this happened

> to anyone else and they were able to get their insurance company to

> pay for the surgery. I am feeling very discouraged and I am just

> startign Ugggh! So any feedback on this situation would be greatly

> appreciated. I thought perhaps they wouldn't cover it because they

> don't want me to start the process of having the surgery and maybe

> they think this would make me think it wasn't possible. Thanks a

> bunch! Laurie in PA

>

>

[Guest guest]

Laurie,

I would call your doctor and ask if there was a mistake because your

insurance company would not over the visit. Ask them to look up the

code and make sure the coded the visit correctly. See if they are

willing to re-code the visit ad re-submit it. Good luck!!!

Hugs!!!

>

> hi all i'm just starting this process and i went to my family doc

so

> he could recommend a good surgeon and to talk things over with him,

he

> thinks I am a great canidate for the surgery. Anyway I paid my

copay

> like always and got an eob from my insurance that said it wouldn't

pay

> for that office visit because it isn't a covered kind of deal. I

know

> my doc put the diagnosis as obesity. I am wondering if this

happened

> to anyone else and they were able to get their insurance company to

> pay for the surgery. I am feeling very discouraged and I am just

> startign Ugggh! So any feedback on this situation would be greatly

> appreciated. I thought perhaps they wouldn't cover it because they

> don't want me to start the process of having the surgery and maybe

> they think this would make me think it wasn't possible. Thanks a

> bunch! Laurie in PA

>

[Guest guest]

I talked to my insurance company today and they won't pay for my office visit of

the diagnosis is obesity but they do cover wls woooooooohooooo! I made sure to

get the name of the person I talked to incase I need to call again. I'm some

what relieved that there is a fighting chance anyway! Thanks for all your

input. Laurie in PA

[Guest guest]

I find that interesting that they will not pay for the office visit but will

pay for the WLS. Maybe you will get to have your surgery after all.

My wife's insurance through the state of South Carolina would not pay for

the surgery, but Medicare did and all I have to say is thank God that they

did.

Lin

Lhsh@...

American by birth,

Saved by the grace of God.

Re: insurance question

I talked to my insurance company today and they won't pay for my office

visit of the diagnosis is obesity but they do cover wls woooooooohooooo! I

made sure to get the name of the person I talked to incase I need to call

again. I'm some what relieved that there is a fighting chance anyway! Thanks

for all your input. Laurie in PA

[Guest guest]

Hmm. That makes about as much sense as not paying for an office visit

with a diagnosis of cancer but they'll pay for the removal of the

tumor. You've got a healthy attitude with big picturing it and not

jumping into their sea of illogic thought.

Thank goodness we have HMOs and insurance. I'd hate to have to figure

out or manage this stuff on my own. YEAH RIGHT.

Mike in GR (bitter old man)

>

> I talked to my insurance company today and they won't pay for my

office visit of the diagnosis is obesity but they do cover wls

woooooooohooooo! I made sure to get the name of the person I talked

to incase I need to call again. I'm some what relieved that there is

a fighting chance anyway! Thanks for all your input. Laurie in PA

>

>