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  1. #1
    Gastric Sleeve Member
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    John Johnson, Jr.
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    Default Help - Endoscopy denied by insurance

    My insurance company has denied the endoscopy - I now have two choices - pay for the procedure myself (waiting to hear back from surgical center as to how much that will be) or go forward with the surgery in which case my doctor wants to talk to me about risks, etc. Have any of you had this experience and of so, what did you do/what are your thoughts/recommendations?


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  3. #2
    Gastric Sleeve Member sraebaer's Avatar
    I have had a gastric sleeve.
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    Default Re: Help - Endoscopy denied by insurance

    No clue, but I know I didn't have an endoscopy before surgery.



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  5. #3
    Gastric Sleeve Member JannyAZ's Avatar
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    06/27/2019
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    Dr. Burpee (that's right)
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    Default Re: Help - Endoscopy denied by insurance

    I have more questions than opinions at this point. Is the endoscopy a requirement of the surgeon? I’m assuming it is. Have you already gotten approval for sleeve surgery from insurance? If not, do you know all of their requirements for approval and will you be able to meet them? My point is this. If you feel you will be able to meet all of the insurance requirements for sleeve surgery, the only barrier is getting the endoscopy done, and you REALLY want the sleeve done then I’d say figure out a way to pay for the endoscopy yourself. Assuming you don’t have insurance approval for sleeve yet and that this is the endoscopy is the surgeon’s requirement (not insurance co’s), I’d get insurance approval for sleeve before doing the endoscopy. Make sense? FYI, my insurance company was billed about $9600.



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  7. #4
    Gastric Sleeve Member KiwiGal's Avatar
    I have had a gastric sleeve.
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    Lisa
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    Stephanie Ulmer
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    Default Re: Help - Endoscopy denied by insurance

    I was not required to have an endoscopy before surgery.
    Is it essential that you have one?



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  9. #5
    Gastric Sleeve Member WANAGL's Avatar
    I have had a gastric sleeve.
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    Cyndi
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    Dr. Robert Marema
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    Default Re: Help - Endoscopy denied by insurance

    JannyAZ has great questions/suggestions.

    I didn’t have to have endoscopy pre VSG.



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  12. #6
    Gastric Sleeve Member
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    John Johnson, Jr.
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    Default Re: Help - Endoscopy denied by insurance

    Thank you all for your responses - apparently it’s not a requirement of my surgeon, but a preference; I was going to go forward without it, but with many phone calls/negotiations we settled on a discounted amount and I’m having it today - thanks again!


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  14. #7
    Gastric Sleeve Member jerzeygirl's Avatar
    I have had a gastric sleeve.
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    Dr. Louis Balsama
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    Default Re: Help - Endoscopy denied by insurance

    It's used for many diagnostic purposes and a couple of them are:
    GERD
    Acid Reflux
    H Pylori

    We require them at our hospital, but many patients who do not fit the criteria and when their insurance doesn't cover it, have surgery anyway. Ask why they're doing the test and if you could have the surgery without that particular testing. I'm sure it's very costly and perhaps not needed for you at all! Good luck!!



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  16. #8
    Gastric Sleeve Member AnnieG's Avatar
    I have had a gastric sleeve.
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    Annie
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    Dr. Ryan Heider
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    Default Re: Help - Endoscopy denied by insurance

    Please remember if your results show anything, you can ask for the bill to be submitted with the diagnosis code, unless your insurance requires pre approval....I have to have one every year because of a genetic thing.
    [I]HW: 240 lbs CW: 205 lbs: SW: 199 lbs GW: 130 lbs

    1 MO = 167.0 2 MO = 156.4
    3 MO = 148.4 4 MO = 140.6
    5 MO = 136.0 6 MO = 130.0 (GOAL)
    1 YR = 122.0 20 MO = 130.0

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  18. #9
    Gastric Sleeve Member Pudsley's Avatar
    I have had a gastric sleeve.
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    Carla
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    Professor Bulbuller
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    Default Re: Help - Endoscopy denied by insurance

    I also had to have an endoscopy so did all the group of people who had all their health checks with me on the day.

    I was self-pay and it was part of our package in total it was about $190 for 12 medical checks a full day of endoscopy psych heart, lungs. ultrasound, blood work. ECG, Liver scan.

    I have to say an amazing price and my surgeon told me 2 weeks ago that he has done 160 sleeves in the month of May which is the average amount each month.

    People fly in from all over the world because he is a Professor AND its 10 days stay in hospital at a package of $2560 for everything no matter what!


    If I had known sooner I would have been there sooner I spent that on food for fad diets in a couple of months.



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  20. #10
    Gastric Sleeve Member
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    John Johnson, Jr.
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    Default Re: Help - Endoscopy denied by insurance

    Quote Originally Posted by AnnieG View Post
    Please remember if your results show anything, you can ask for the bill to be submitted with the diagnosis code, unless your insurance requires pre approval....I have to have one every year because of a genetic thing.
    Thanks so much for this info, I appreciate it!


  21. #11
    Gastric Sleeve Member
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    John Johnson, Jr.
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    Default Re: Help - Endoscopy denied by insurance

    Quote Originally Posted by Pudsley View Post
    I also had to have an endoscopy so did all the group of people who had all their health checks with me on the day.

    I was self-pay and it was part of our package in total it was about $190 for 12 medical checks a full day of endoscopy psych heart, lungs. ultrasound, blood work. ECG, Liver scan.

    I have to say an amazing price and my surgeon told me 2 weeks ago that he has done 160 sleeves in the month of May which is the average amount each month.

    People fly in from all over the world because he is a Professor AND its 10 days stay in hospital at a package of $2560 for everything no matter what!


    If I had known sooner I would have been there sooner I spent that on food for fad diets in a couple of months.
    Wow, that’s an amazing package - good for you!


  22. #12
    Gastric Sleeve Member
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    John Johnson, Jr.
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    Default Re: Help - Endoscopy denied by insurance

    Endoscopy was a piece of cake - talked with the surgeon who told me he’s done over 2,000 surgeries and my endoscopy was the only one denied; apparently because I’ve never been prescribed medication for my GERD issues - in any event it’s behind me and I’m still on track toward my healthy life!


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  24. #13
    Gastric Sleeve Member Pudsley's Avatar
    I have had a gastric sleeve.
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    Carla
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    Professor Bulbuller
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    Default Re: Help - Endoscopy denied by insurance

    Whoo Hoo!

    Yay Great news!

    You are another step forwards and well and truly on your way.

    Keep us posted.



  25. #14
    Gastric Sleeve Member WANAGL's Avatar
    I have had a gastric sleeve.
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    Cyndi
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    12/30/2015
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    Dr. Robert Marema
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    Default Re: Help - Endoscopy denied by insurance

    Quote Originally Posted by lorrietime View Post
    Endoscopy was a piece of cake - talked with the surgeon who told me he’s done over 2,000 surgeries and my endoscopy was the only one denied; apparently because I’ve never been prescribed medication for my GERD issues - in any event it’s behind me and I’m still on track toward my healthy life!
    Great news!



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