OH GOSH NOT AGAIN

Well guys I finally got a letter from my insurance company today, what I thought was going to be my approval letter. But now I am more confused that I was before. Can any of you make any sense of this? Dear Mrs. Grissett, Future Health is the medical necessity review agent for your employer. The above reference4 Laparoscopic Roux-en-Y By-Pass procedure has been reveiwed and has been determined to be medically necessary. This is not a guarantee of payment. Medical necessity is only one condition of coverage. Payment is also subject to benefit limitations and eligibility requirements established by the member's health plan contract. Future Health is not authorized to determine whether those other requirements have been met or the amount of any payment. Benefit details must be obtained from the provider service or customer service phone number on the member's identification card. Please note, if the above procedure requires an inpatient hospital admission, precertification must be obtained by contacting Future Health Corp. toll free at the above number. =================================================== Now guys what all does that mean? The number they gave for me to precertify is the number I have been working with all along. Man will this ever end. Is my bubble bursted or what? Sue

Insurance is always confusing. I have Federal Blue Cross. My book says it definately pays for the surgery. When I called them, they said, well the book says it will, but even if it is a medical necessity, the book's is not a guarantee of payment. They paid. A lot more than I expected. I was very proud. But insurance companies always have this double-talk to keep you confused. Since they are saying that it is medically necessary, it probably means that you have been approved. That's my guess anyway. Susan 315/305/248/150 55 yrs old 5'6"

Sue, This is legal jargon to cover their butts. They determined that it was medically necessary -- now it's up to the insurance company to actually pay the bill. Not a problem. If your ins. coverage includes this procedure, you won't have a problem. They are just saying this incase you are one of those people who have, for example, met thier lifetime limit, not met deductibles or copays, etc. If I remember correctly, your insurance says it's covered if medically necessary -- so you are free and clear. Just call them Monday to verify. Don't sweat over it. I got a similar letter. Don't panic till Monday! HUGS! Kimberly

Sue, It still sounds fine to me! Call them first thing Monday morning and let us know what they say. I dont think your bubble is bursted. Medical Necessity is good. At least they didnt say that it wasnt medically nessecary --my first denial said that. Dont fret over it.. Enjoy your weekend. It sounds okay.

I think it's a go, girl!!! smoochies Arlies Surgery date: January 11, 2005 highest/surgery day/current/goal 521.2/491.2/393.8/160 that's 127.4 lbs gone last count and only 233.8 to go.......

Hi Sue, I feel like the others, it is medically necessary. That's it! You are covered. At least, that is the way I feel. Keep smiling! Jan

Sue, I think it's the insurance companies jobs to keep us dazed and confused. Don't sweat it girl! They've already said it's medically necessary! They just wanna drive you ... don't let'em! Love ya sweets! Kimberly

Sue, My approval letter read the same way. When I called they said it was like that just in case your coverage was cancelled or something crazy like that. As long as you are still covered they will pay. Don't worry...Be Happy... Becky