Help help!!!!!!!

My employer has switched insurance plans since my surgery. my current insurance company will not cover any of the aftercare with a surgeon and pcp doesnt really know what she should do to help me with aftercare. I cant afford the out of pocket expenses to see the surgeon on my own any suggestions.

1) what type of surgery did you have 2) is the insurance excluding the care becasue your surgeon is out of network or becasue they dont' cover the type of surgery you had? 3) talk to the surgeon about billing the aftercare differently so it looks like something more general- he can use different ICD 9 codes- than a surgial code.

Ummm, well, your insurance really CANT refuse to pay for your surgical followup care. It sounds like they're trying to say you have a pre-exisiting condition that they don't think they need to provide coverage for. Did they say something like that?? You need to get on the phone with them AGAIN. We've got this funny little law here called HIPPA which should cover this problem for you. I's a law that your insurance- as long as you've been CONTINUOUSLY insured- (meaning you haven't had a "significant break in coverage" whi*****T the requirement for creditable coverage is - 120 days (or 150 days if the loss of prior coverage was due to an involuntary job loss) the insurance can not deny you coverage for your pre-existing condition and has to pay for the follow up for the condition. So -long and short of it is- that you have a medical reason for the surgical follow up and they need to cover it. It doesn't matter at all if they would or would not have covered your gastric bypass. Your future visits would not be coded to refer to gastric bypass at all, they are simply surgical followup. Your PCP probably will have to write you a new referral for the surgical visits, but that's about it. If your condition can not be considered 'pre-exisiting' (i.e. you've benn continuously covered with no 'significant break in coverage') and you're not able to get a reasonable AND SPECIFIC answer for WHY they won't pay for your medically necessary followup (which would be them saying that they are denying you coverage for a pre-existing condition- which is ILLEGAL) then you should get with a lawyer or your employee benefits person at your job and make sure they understand the situation and go to bat for you. The reason I know this is because I switched CTCare policies at about 1 year post-op and they tried to pull that crap on me. Since my NEW policy would not have covered gastric bypass, the tried not to cover the follow up from it. I went ballistic when I got the denial for my surgical visit. I called them and they tried to give me this load of BS...once I got a supervisor and started talkpin to them about HIPPA law- they realized i wasn't some ding dong that they were going to be able to brush off without a fight- so they didit he right thing- which is what they should have done in the first place- and just said it was a 'misunderstanding', but required that I get NEW referrals to my surgeon from my PCP and since then have covered EVERY SINGLE LOVING VISIT AND TEST that I've needed since then Good luck to you. Don't give it up without a fight..