SARPE - Time between consultation and surgery

[Collie]

Hi everybody!

I had my consultation for SARPE yesterday and I had a quick question for everyone who's had this done. How long did you wait between your consultation and your actual surgery date? I asked my surgeon and he said that they had to get pre-authorization from my insurance before we could set a date, and to wait for a call from their insurance coordinator dude. I didn't think I would be going through my medical insurance at all since my deductible is so high, but he insisted since they are supposed to cover anesthesia, hopsital fees, all that. I'm sure everybody's experience will differ but I really have no idea here how long that normally takes. Obviously I'll give the office a call next week if I don't hear anything, just wanted to hear other peoples experiences as far as timing goes. Thanks in advance!!!

[Sideways]

I'm curious about this too! The surgeon I spoke to about a SARPE actually takes payment directly from the patient and then files for reimbursement later, so there was no delay between consultation and setting up a surgery date-- but there was a big issue with making sure you get your money back.

I'm not surprised that they want to go through your medical insurance, however. Even with a high deductible, hospital fees and anesthesia adds up very quickly, and is a monster of a cost if you have to pay out-of-pocket or out-of-network prices.

[HiKitty]

I went in for my official surgery consultation March 31. I waited for months to hear back from the insurance company to finally hear back in June that it was approved!
Rubber spacer bands were scheduled to go in end of July (ortho is backed up because all of the kids are out for summer) and the impression for the expander was taken last Wednesday. This Wednesday the expander is going in and next Tuesday is my surgery. So, to answer the question, it was 138 days from consultation to surgery.

[EWUgal15]

It's different for everyone, to be honest. I didn't need SARPE, so I don't know if the insurance process is any different. It was a year between my consult and surgery for BSSO. After my consult, a pre-authorization was filed with my insurance which took 6 weeks to get back, mostly because we hadn't set a date yet. Once I had actually scheduled the surgery, the insurance coordinator at my surgeon's office submitted a new pre-auth that came back much faster because they had a time frame to work with. If your insurance comes back needing more info or they seem to be dragging their feet, you can try lighting a fire by actually setting a date. Then if they don't approve it for some reason, you can move your date around while you work out the kinks with insurance.

Hopefully your insurance its a little more friendly than mine was!

[Collie]

I went in for my official surgery consultation March 31. I waited for months to hear back from the insurance company to finally hear back in June that it was approved!
Rubber spacer bands were scheduled to go in end of July (ortho is backed up because all of the kids are out for summer) and the impression for the expander was taken last Wednesday. This Wednesday the expander is going in and next Tuesday is my surgery. So, to answer the question, it was 138 days from consultation to surgery.

138 days?!?!? omfg...I'm going on a month now and I am getting so frustrated! I've checked in with the poor insurance coordinator every week, last update was the insurance company needed more information/records, that was almost two weeks ago. Argh. Sorry it took so long for you, thats crazy! Best of luck with your surgery!!!!!

[Collie]

It's different for everyone, to be honest. I didn't need SARPE, so I don't know if the insurance process is any different. It was a year between my consult and surgery for BSSO. After my consult, a pre-authorization was filed with my insurance which took 6 weeks to get back, mostly because we hadn't set a date yet. Once I had actually scheduled the surgery, the insurance coordinator at my surgeon's office submitted a new pre-auth that came back much faster because they had a time frame to work with. If your insurance comes back needing more info or they seem to be dragging their feet, you can try lighting a fire by actually setting a date. Then if they don't approve it for some reason, you can move your date around while you work out the kinks with insurance.

Hopefully your insurance its a little more friendly than mine was!

This is actually what I was thinking of doing, just asking the office to set a date and hope everything is settled by then, but I'm scared of requesting all this time off of work and then having to change the date last minute. Ugh.

[HiKitty]

[/quote]138 days?!?!? omfg...I'm going on a month now and I am getting so frustrated! I've checked in with the poor insurance coordinator every week, last update was the insurance company needed more information/records, that was almost two weeks ago. Argh. Sorry it took so long for you, thats crazy! Best of luck with your surgery!!!!![/quote]

It was worth it, though. I have an out of pocket max of $2500, and 10% after that, so my SARPE surgery will be $540 as opposed to $5400

[Collie]

138 days?!?!? omfg...I'm going on a month now and I am getting so frustrated! I've checked in with the poor insurance coordinator every week, last update was the insurance company needed more information/records, that was almost two weeks ago. Argh. Sorry it took so long for you, thats crazy! Best of luck with your surgery!!!!![/quote]

It was worth it, though. I have an out of pocket max of $2500, and 10% after that, so my SARPE surgery will be $540 as opposed to $5400[/quote]


Nice!!! My insurance isn't that great unfortunately, I know I'll still end up paying a crapload out of pocket but at this point i don't even care, I just want to get it done!

[HiKitty]

I'm dealing with all the extra fun right now since my surgery is tomorrow morning.
paid $750 for the procedure....
Then the hospital wants $27000 for the day-long stay (copay will be $1800)
Not to mention the anesthesiologist and everyone else that will send me bills after the fact.

[Collie]

So after two months of waiting.....DENIED My surgeon's office is appealing the denial of course, but that means another month of waiting. This sucks!