HELP INS. DIDN'T PAY AFTER APPROVAL!!!!!!

Can someone help any advice would be appreciated. I went through everything thinking insurance would pay 70% but it paid 0%. I got a letter of approval May 4th went for preop and had lap band june 15th. Now bills are totaling over 22000.00 at this time. I getting ready to contact Anthem and Georgetown to find out what is going on. I am thing it has something to do with me choosing Dr. Tom instead of weiss or oldam because it was during the time everything was changing at GT.my approval was based on the group before Dr. Tom. someone should have caught this if it is the case . I NEED HELP !!!!!!! Thanks Tammy_m

Tammy, go on the main lapband forum and look for a lady named Vicky,  her posts always say insurance guru or something like that.  In the mean time I will look and see  if I can find her posts and send you to her. 

Jacqueline

Tammy, 

Here is a link to Vicki's profile. 

http://www.obesityhelp.com/member/cutiedoll58/

You can ask her about it and she will help you. 

Jacqueline

Oh boy, what a mess!  I hope that you are able to get this straightened out.  Are you sure that Dr. Tom is part of your network?  What are your benefits for having surgery with someone out of network?  I can seem them balking at paying HIS fee, but isn't the hospital itself in network?  If so, at the very least they should be paying for those charges and they are probably the biggest chunk of those bills.

I was a self-pay patient and ended up spending just over 20K on my surgery.  $16,500 of that was paid directly to the hospital.  That's why I'm thinking that they should at least pay the hospital part if the hospital itself is in your network.

Have you spoken with Dr. Tom's office manager?  I can't imagine that they didn't know to look into this before you had surgery.  Be prepared though because the insurance company is going to say that it was your responsibility to check with them to be sure that Dr. Tom was in network before he did your surgery...

I'm certainly no expert on any of this though so I encourage you to speak with the office manager at your doctor's office and to someone at the supervisory level at your insurance company.  If all else fails, consider hiring an attorney to help you.

Good luck!

You could pm vickie...she is on this board sometimes.  And is a really terrific gal.
good luck and I am sorry
teach

Tammy, the place to start would be with Georgetown.  They are the ones who send in your approval to the insurance.  Speak to them I am sure they will help you out. 
Hope this works out for you!
Brenda

Thanks everyone I did contact Dr. Sonnastine's office and was told this is common for the insurance and that they were working on it . I was sure glad to here that. Thanks to everyone for their advice Tammy_m