Remingtonh
Well-Known Member
Hi all, I decided to move my thread over here since I've hijacked the other thread enough already.
I just got off the phone with Dr. Ayoola's office, and we talked at length about insurance and the DS (with the staff not the doctor).
They essentially told me that, though it's not the "official" policy of their practice, they tend to not do DS surgery on patients with less than 50 BMI, because insurance companies make it difficult.
I advised them that I spoke with my insurance company in detail and they told me that my policy covers the DS, and there is no differentiation between 40 BMI or anything higher.
I asked her about the pre-authorization process, and what she told me matched what the doctor told me, in that even if the surgeon gets pre-authorization from the insurance company, schedules the surgery and completes it, the insurance company can still deny coverage when it comes time to pay the claim.
I pointed out that if that's true, then it could happen with any surgery, not just the DS. So my thinking is that the doctor believes there is a greater chance of that scenario occurring with the DS vs. RNY or other lesser procedures, and requires prepayment for the procedure, with the expectation that the insurance company may ultimately deny the claim.
It seems Dr. Ayoola's office might have the same concerns as the doctor. I haven't moved that far with them yet, but that's definitely what they were suggesting to me.
Unfortunately this might mean the DS could be out of my reach at this point. I just don't know if I'm willing to risk $8K. I'll have to seriously re-think this.
Has this happened to other people seeking DS surgery?
I just got off the phone with Dr. Ayoola's office, and we talked at length about insurance and the DS (with the staff not the doctor).
They essentially told me that, though it's not the "official" policy of their practice, they tend to not do DS surgery on patients with less than 50 BMI, because insurance companies make it difficult.
I advised them that I spoke with my insurance company in detail and they told me that my policy covers the DS, and there is no differentiation between 40 BMI or anything higher.
I asked her about the pre-authorization process, and what she told me matched what the doctor told me, in that even if the surgeon gets pre-authorization from the insurance company, schedules the surgery and completes it, the insurance company can still deny coverage when it comes time to pay the claim.
I pointed out that if that's true, then it could happen with any surgery, not just the DS. So my thinking is that the doctor believes there is a greater chance of that scenario occurring with the DS vs. RNY or other lesser procedures, and requires prepayment for the procedure, with the expectation that the insurance company may ultimately deny the claim.
It seems Dr. Ayoola's office might have the same concerns as the doctor. I haven't moved that far with them yet, but that's definitely what they were suggesting to me.
Unfortunately this might mean the DS could be out of my reach at this point. I just don't know if I'm willing to risk $8K. I'll have to seriously re-think this.
Has this happened to other people seeking DS surgery?
Last edited: