Insurance covers Dr. Hornbostel & Bothwell but Bothwell won't accept it??????
Ok my dear MO message board friends. I think I am a fairly intelligent person (LOL) but maybe somewhere I've lost command of the English language.
Here's the story...
On Friday, July 21, I was told by our NEW insurance company, United Health Care, (my husband's company was bought out and we were under Cigna where everything was going well) that Dr. Hornbostel and Bothwell Regional Medical Center are on the "IN-Network" list and bariatric surgery is covered as long as 1) You are morbidly obese (BMI of 40 or higher); 2) You have been morbidly obses for at least the last 5 years and it can be documented by a doctor; and 3) You are at least 21 years old.
Unfortuinately, I meet all of the above conditions
and Dr. Hornbostel has no problem with the insurance. However, Dena tells me that Bothwell will not let them admit anyone with United Health Care because they have a set contract fee for the surgery and if you should develop a complication during or after the surgery and require additional days in the hospital, the insurance won't pay for it and the hospital will have to "eat" the difference.
In addition to United Healkth Care, I also have Medicare due to a disability which I would think would pick up whatever United Health Care doesn't. So how would Bothwell end up "eating" anything?
Dena talked with a Steve Davis 
who does the contracts at the hospital and he told her that the only way the hospital would admit me is if I got a "denial" 
from United Health Care and then they would take me as a Medicare patient. I called United Health Care again and asked to speak to a supervisor to clarify things. I was told that if I developed complications the doctor would only need to request additional days and I would be covered. She also said that my husband's United Health Care contract with Bothwell Regional was renewed on 10/15/2005 and is currently in effect.
So what gives????: I am supposed to meet with Dr. Hornbostel this Wednesday and I really don't know what to do.
Has anyone else experienced this kind of problem? How can a hospital deny you treatment if they are considered "In-Network" and have a valid, on-going contract??? What am I missing??? Can anyone please give me some advise?
Thank You,
Theresa
Here's the story...
On Friday, July 21, I was told by our NEW insurance company, United Health Care, (my husband's company was bought out and we were under Cigna where everything was going well) that Dr. Hornbostel and Bothwell Regional Medical Center are on the "IN-Network" list and bariatric surgery is covered as long as 1) You are morbidly obese (BMI of 40 or higher); 2) You have been morbidly obses for at least the last 5 years and it can be documented by a doctor; and 3) You are at least 21 years old.
Unfortuinately, I meet all of the above conditions and Dr. Hornbostel has no problem with the insurance. However, Dena tells me that Bothwell will not let them admit anyone with United Health Care because they have a set contract fee for the surgery and if you should develop a complication during or after the surgery and require additional days in the hospital, the insurance won't pay for it and the hospital will have to "eat" the difference. In addition to United Healkth Care, I also have Medicare due to a disability which I would think would pick up whatever United Health Care doesn't. So how would Bothwell end up "eating" anything?
Dena talked with a Steve Davis who does the contracts at the hospital and he told her that the only way the hospital would admit me is if I got a "denial" from United Health Care and then they would take me as a Medicare patient. I called United Health Care again and asked to speak to a supervisor to clarify things. I was told that if I developed complications the doctor would only need to request additional days and I would be covered. She also said that my husband's United Health Care contract with Bothwell Regional was renewed on 10/15/2005 and is currently in effect.
So what gives????: I am supposed to meet with Dr. Hornbostel this Wednesday and I really don't know what to do. Has anyone else experienced this kind of problem? How can a hospital deny you treatment if they are considered "In-Network" and have a valid, on-going contract??? What am I missing??? Can anyone please give me some advise?
Thank You,
Theresa I'm sorry to hear that this is becoming confusing for you. It sounds like your surgeon's office needs to get on the phone with UHC to clarify things. I can't imagine how an insurance company will cover a surgery, but then say "too bad" if you develop complications. I'm sure once your surgeon's office gets things straightened out, it won't be any problem. Good luck!
Pamela
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