Needing Advice Please

Hello Everyone
I'm in need of some advice/help and hope that ya'll can help.

I went today for my blood tests & my family doctor's office scheduled my stress test and proceeded to schedule a lower extremity venous testing.  She (the office manager from my f/d) was then informed that insurance does not pay for that testing, it would come out of my pocket, & that it's quite expensive. 

Then (if that wasn't bad enough news to start off my day), she proceeded to tell the office manager from my f/d office, that most likely I haven't even been cleared with my insurance company and have been given the "run around".

I'm frustrated & confused, as I was told by my bariatric doctor's office that I was denied by Cigna (my primary insurance) for the lap-band; but that my 2nd insurance (Anthem) would be covering the surgery.   When I went to see my bariatric doctor, Jorge Rodriguez, he told me that after I have these last tests I should be looking at having my surgery mid February / early March.   I guess what I'm asking is who do I believe -- am I really getting the "run-around", was the woman telling my family doctor's office (and me) correct information?  Needless to say, I cannot afford to pay for this surgery out of pocket.   Hopefully I've made sense of all this, I'm sooo upset.
Many thanks in advance for your help and support. *hugs* Libby

Libby, we have an insurance woman on this site that may be able to help you, her name is Vicki.  I really don't have a clue but Anthem paid for my surgery and the stress test too.  See what Vicki has to say, she is the insurance Guru.  If anyone can help, she is probably the one.

Z

Thank you!

I'm so frustrated and wasn't sure where to turn.  'Glad to hear that Anthem paid for yours - there's hope for me yet!

*hugs*
Lib-

I would look on your insurance card and call them yourself.  I wouldn't wait to hear from this dr or that one.  I would want to hear it from the insurance company. Get the name of who you speak to also. I have Anthem insurance through my employment with the state of Indiana.  Anthem covered my RNY 100%.  When I got approved I received a letter from them stating that they were covering the surgery and I was allowed to stay up to 2 nights in the hospital barring any complications of course.There was a handbook from Anthem too showing what is and is not covered.  And it listed all the requirements that had to be completed prior to surgery... ie Psych evaluation, dietary consults,6 mos of other methods of weight loss etc...

Thank you Leah -

I was going to today & was worried if I did contact Anthem I'd be messing up (being covered ) if the information that was told to me was correct & my bariatric doctor's office hadn't gotten their approval yet.

'Good to know about the letter, handbook & requirements that they send, as I have not received anything from them which does make me wonder about being approved.

I think what I'm going to do is call my bariatric's office & ask for the Anthem's authorization # for surgery and/or who they spoke to -- then call Anthem and confirm.
*hugs*
Lib-

Whether or not your weight loss surgery gets approved if you have your family doctor order the tests I would think it would be covered since they won't realize it's in preparation for bariatric surgery.  This is how I hade all of my testing done and paid for through my insurance.  I was self-pay for the actual surgery so every little bit helped!

Has USA submitted to your insurance for approval for the surgery yet?  Normally they don't do this until they have all the tests completed so they can submit it at the same time.

They had told me that Anthem was covering it.  But after reading what Leah wrote, I'm wondering if they had contacted Anthem, or just assume that they would cover me.

Thank you for responding - it seems that whenever I take a tiny step forward, I slide back 2 feet when it comes to preparing for the surgery.  I'm frustrated & confused needless to say.  And ready to cry. 

I've already "been lost" within all the testings (twice with the sleep study) and today was almost the last straw for me.

Self pay - whew!  Good for you!!!
*hugs*
Lib-

I dont know if this helps.
But my first go around my dhs insurance did not pay for the surgery,but they did pay for the sleep study and and the rest of the test the dr ordered.
Good luck and just keep on them sweetie...

Thank you - Sorry for not responding earlier, I had to work all day & didn't get home until late.

Yes, my insurance did pay for the sleep study as well, and some of the testings.  I called & spoke to my bariatric office yesterday & informed them what the woman at the office (where my next tests will be preformed) said and she explained what the woman meant and how the woman mis-spoke concerning my being covered by insurance for the testings.

It seems the main thing is to keep on them ... "I am woman, hear me roar!"
Once again, many thanks for the kind words & support
*hugs*
Libby

Libby...do not give up! You are your best advocate on this. I going to go out on a limb and assume it was Bridget at USA that you have or will deal with. Be informed on your own first. Everyone is right about calling your insurance yourself. if you do not have the handbook...request one. Log dates, names and times you spoke with them. Hell...ask for a letter to confirm everything they told you in that call even. if they a company of character they will do it.  When I talk to a client I write them a letter to memorialize our conversation so that there is a record for both the atty and the client as to what was discussed. No confusion. Definitely ask Vicki...she is awesome with all this and can definitely steer you in the right direction.