got a letter from insurance need help understanding CONFUSED

below is the letter that i got from the insurance today and i have asked my surgeons office about it and she is going to review it but i was hoping someone here could help me understand i typed it word for word: Dear Ms. Roby Per your request, a review for preauthorization for gastric bypass surgery on the above patient has been completed. This procedure is a noncovered expense according to the plan benefits. This is not a guarantee of payment,only a quotation of group benefits. Benefits will be paid in accordance with the terms and limitations in effect at the time the expenses are incurred.

It means it was reviewed by the dept who passes the buck Hopefully the insurance coordinator at whatever surgery center you are using will know what to do to clarify the answer. Sounds like they are denying you and you may have to start appealing???? Sure you will get your answers soon...it's hard to wait isn't it???

well see i called my coordinator and she said that it sounds like a denial but then they go on to say that they are going to pay so i dont know i have my paperwork from hubbys insurance and now where on there does it say that its not covered so i am going to send that to my coordinator and see what she thinks i hate insurance companys

Yeah...what Ellen said... That's a standard reply....the key sentence to look at is they don't cover WLS. So get ready to begin your appeal. Good luck

Amanda, I got a similar letter the first time. It means you are denied & have to do a appeal. The clause the put on the bottom is a standard sentance they put on ALl replys, to justify saying what they will pay & not gaurenteeing it. I also got a leter 2 days before my surgery with the same statement & 7 days after- but my Ins. did come thru. Start your appeal right away, & don't give up!! Ellen

i am working on my appeal and my coordnater is working looking into the exclusion because its not on any of the paper work that we can find anywhere

You will need to go to the exclusions section of your policy book...and look for weight loss surgery or gastric bypass. That is where you will find the exclusion. Just keep appealing....I have heard of some people appealing 2-3 times before they got their approval.

we dont have a policy book they just give out papers explained what they cover

you need to ask for a copy of the policy has to be one even if Human resourses has a copy to make you a copy...and i know we make it sound so easy, but its not, all the road blocks and dead ends, and then you have to figure out another way to do whatever..

It is on-line....someone posted the site to you earlier. Ya just gonna have to get some of the answers yourself....the one person on here who has responded to you that they have the same policy gave you the site I think...you will have to read back thru all the posts and find it. Sorry it's frustrating....keep doing your research. And as Angie said, you can call and get the policy book. BUT they told you in the letter that gastric bypass is NOT a covered procedure. You are going to have to appeal (read previous posts about appeals....I think someone posted some places to view sample appeal packages). Good luck with your appeal....gotta keep fighting the good fight. Sometimes it takes a few years to win...so be patient and go ahead and start your doctor supervised weight loss program while you are waiting. It certainly won't hurt...and if they come back with a 6-18 month supervised diet...you will already be ahead of the game.