Question:
Surgeon requires gall bladder ultrasound, worried about insurance covering the cost.

I am having Lap RNY next week and my surgeon requires a gall bladder ultrasound. My insurance will only cover this if it is medically necessary. I haven't had any pain that I know is gall bladder related. Would insurance cover this?    — Kendra S. (posted on February 20, 2003)

February 20, 2003
Theres really no problem w/ins covering that...just call Dr. office and tell them your surgeon needs a refferal for an ultrasound... They didn't even ask me why...They called my ins and I had a referral for it that day...
   — Snowflake48342

February 20, 2003
I hate to say this, but sometimes it's necessary to "embellish" the truth a bit. If you truly suspect they'll give you a hard time about paying for this test, then suddenly "developing" a right-sided pain would most likely ensure the bill being paid. Saying you have pain there won't change the results any, so your surgery will be fine. Good luck!!
   — thumpiez

February 20, 2003
I wouldn't worry about insurance coverage. Most of the time, if the surgeon feels it is necessary, it will get paid. The people who will make the arrangements know what codes to use to get it covered. Most insurance companies don't question things to that extent any more. (My husband had to have caridac clearance and after one test, a small problem was detected requiring another test - all covered, even though there was actually no problem of any consequence.) If the surgeon deems the test medically necessary, it will be paid.
   — koogy

February 20, 2003
It's actually to the insurance company's benefit for you to have this done. If you do have gallstones, then you can have it taken out when your WLS is done. They don't have to pay for a second hospital stay, surgery, anesthesiologist, etc. Also, just because you've never had any problems doesn't mean you don't have gallstones. I had only one gallbladder attack (and attack is absolutely the right word) before I had it taken out. However, I'm sure the problem had been developing for quite some time before it made itself known.
   — garw

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