Hubby's Insurance Co is on Drugs
I have been struggling to get my hubby's insurance to pay for the WLS for months. They pre-approved it but because I have another insurance which is my primary...they needed proof that primary wouldn't pay. They sent me letters saying they requested the info from my primary. Well, what they didn't tell you was that the letter just SAYS they requested info from the primary when in fact they wanted it from us. Of course, we had it. So after bouncing around...I sent it to them Labor Day. On the letter I specified all the claim numbers (hospital, surgeon, anesthesia, etc) that were involved for the surgery.
Finally they paid the hospital. I was thrilled. We wait for them to pay the surgeon. Nothing. Surgeon's office is calling me saying "it's been 5 months...someone needs to pay." I keep giving them updates.
Hubby calls insurance they said "we are waiting on you to provide info from primary". He points out that they have it. Gets an "oh yea..." Wait some more. He calls again, firmer this time. Finally someone gets the claim and I called the other day and found out they cut a check on Monday. When I see the surgeon yesterday, I tell them the good news.
That was...until I got my copy of the claim today. The bill was for $7500. Supposedly, the PHCS discount provide is $7178.40. So the surgeon was paid $289.44. 
I call the insurance company and ask... what is up with the payment? How can $7500 be discounted to $300? The gal says these are lucrative contracts between doctors and insurance providers. I say "what doctor would even TOUCH a patient and do surgery on them for $300????" Makes no sense. His malpractice insurance per patient is probably more than that. The gal then asks "well what type of surgery was it?" I tell her "gastric bypass surgery". She says "Oh, yea, that doesn't make sense. But until the doctor's office calls them about the amount, they cannot do anything.
OMG. I am so..... 
. Luckily most of my post care has been paid for by my primary who effective 7/1 DOES pay for WLS.
So now Monday morning I have to deal with the surgeon's office yet again. 
Kathy
I call the insurance company and ask... what is up with the payment? How can $7500 be discounted to $300? The gal says these are lucrative contracts between doctors and insurance providers. I say "what doctor would even TOUCH a patient and do surgery on them for $300????" Makes no sense. His malpractice insurance per patient is probably more than that. The gal then asks "well what type of surgery was it?" I tell her "gastric bypass surgery". She says "Oh, yea, that doesn't make sense. But until the doctor's office calls them about the amount, they cannot do anything.
OMG. I am so..... . Luckily most of my post care has been paid for by my primary who effective 7/1 DOES pay for WLS.
So now Monday morning I have to deal with the surgeon's office yet again.
Kathy 
Didn't feel too bad after my CT scan (wow, those things are lightening quick these day) but then I ate lunch. Boy did my side hurt after that - probably the worst it has been yet. I see the gastroenterologist on Tuesday. He should have CT scan results. So...hopefully the answer is near.
I need to check out an anti-ulcer diet and see if changing what I eat will help. Lunch was meat pizza. You take ground beef and brown it and mix with some cheese and use it as a crust. Put it on your pizza stone then top with tomato sauce, cheese and pizza toppings and bake til bubbly. It's rocks. I suspect that if I do indeed have an ulcer, the tomato sauce being acidy was not received well. 
Thanks!
Kathy
Thanks!
Kathy 
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