Horror Stories

I have read a few horror stories where people get approved for a surgery / revision but then after they have it done the insurance refuses to pay for some reason for another. This freaks me out! Any advice on what to be clear of before hand in order to help decrease the chances of this happening?

Mandy

Hi Mandy,

I would make sure your surgeons office calls and gets approval from your insurance.  when they call you to say you got it, make sure you write down who said what at the office. ask if they got the reply from the insurance company in writing and get a copy. also make sure you call your insurance provider and see that they gave approval, again ask names and write dates and times.  they also have to record that they talked to you that day i believe.  you didn't say which insurance company you have, maybe change your post to that and ask for experienced wls patients to reply also.  make sure that you fulfilled your obligation that is required by your insurance company, research it deeply.  like psych evaluation, 6 month dr. approved diet that is recorded at his office... etc.

good luck in your journey!

BM

Hi Mandy,

I speak from experience here.  This actually happened to me. (well, sort of)

I went through all of the steps that I was required to do for my insurance company (BCBS-PPO) and was all approved.  I set the date for my surgery and found out that I was being down sized from my job and losing my insurance.  I was bummed but I thought that this was just a minor bump in the road to my WLS but I will get past this.  I was lucky enough to get a new job immediately and got new insurance.  I looked at the requirements for WLS on my new insurance (BCBS-HMO) and it looked like I was going to out of luck for WLS because they were not approving RNY at that time.  I decided that I would use COBRA from my former employer to have the surgery and still have that covered.  I called BCBS and confirmed with them that I would still be covered and documented who I spoke with and the date and time.  I started my new job and in turn my new insurance kicked in.  Two weeks after my start date I had my surgery and took 2 weeks of to recover.  While home recovering, I received a call from the hospital where I had my surgery and they informed me that my insurance was denied and that I would be receiving a rather large bill.  I flipped out and immediately called the insurance company/dept that I was getting my Cobra from and they said that they did not get a claim.  I called the hospital back and asked to speak with a supervisor and she could not have been nicer or more helpful.  I explained to her that I have insurance from my new job and Cobra from my old job, she called the insurance company and within a day or two, it was all cleared up.  I will admit, I was sweating it out for a few days, but in the end, it all worked out.

Lessons learned here Mandy are to do your homework, document all conversations with the insurance and most of all get anything and everything in writing.  If you do your homework, then you are covered.

Best of luck with your journey

Rob

 Thanks Boxermom and Rob I do appreciate the replies. I have Aetna right now and have posted this question to several forums and the consensus seems to be to get it in writing and document so I'll be sure to do that. It's just always scary to me because seems like insurance companies try to drop the ball whenever possible. Glad it worked out for you, Rob. That would have made me sweat too! Geez. Thanks again.