MY SURGERY NOT COVERED??? OMG!!!! LONG

Okay, so as most of you know, I had my surgery, March 5th, went thru all my preop and approval thru Tricare (my Insurance) I had my surgery, everything has been wonderful with it, I couldn't be happier!! WELL yesterday I got a phone call from Pitt Memorial Billing Department and she says that Tricare paid every penny for my surgery, several months ago, but about a month ago, they TOOK EVERY PENNY BACK and said that my surgery is not covered!!!!!!!! OMG seriously???? So right now, I have a $44,600 bill hanging over my head, because Tricare decided months later AFTER I had my surgery that it is not covered!!!  Is this legal??  I was APPROVED, isn't that what the whole process is for??  Soooo the lady is telling me she needs a payment within 30 days, I tell her NO WAY, my husband is active duty Marine Corps and Tricare DOES cover this surgery, she said that her and her supervisors went to Tricares website and found that they in fact DO cover gastric bypass, but they don't know why Tricare refused to cover my surgery! I guess they have done a few appeals and Tricare denied them all!!   I was BAWLING and sooo sick to my stomach yesterday!! I told her If i would have had to pay there is NOOO way that I would have had the surgery, we simply cannot afford it!! I was actually told even by the Tricare nurse that it was 100% covered!!!!  And everyone else who has the surgery thru Tricare IS covered!!! WTH?? Has anyone ever heardd of an insurance company, taking the money back AFTER a procedure has already been done???
Well i have followed up with a Tricare rep and she is really helping trying to figure out WHY!!! So please please say some prayers for lil' ol me, this just doesn't even seem real!!

JAMI

What Happened!!! I hope and pray that this is just some large screw up at Tricare. I don't have any words of wisdom, but I will be looking for any updates you post. Best of luck to you and remember to write everything down (names, dates, times, etc)

Spark

Spark LOVE THAT AVATAR.
To get to the emerald city all you need to do is Follow The Yellow Brick Road.
Dont ever give up and know you are amongst friends here.
                                     Annie

OMG Jami that is freaking retarded.  There is no way they can do that.  Let me know what happens.  Hopefully they will figure this out soon!!!  I will say a few prayers for you!!

Amanda

Jami,  My first instinct is to tell you not to worry, there has got to be some sort of mistake.  But HA...I would be worrying my heart out if I were you.  {{{Hugs}}}  Seriously, there has to ******ror of some kind.  They do cover gastric bypass, you were approved for the surgery, they just have to act together and come through for you.  You are definitely in my thoughts.  Will anxiously watch for an update from you! 

DONT WORRY YOU WERE APPROVED!!! I have the same insurance as you do and have NEVER heard of such a thing!! They should have it all in the computer that you got approved!! you had to have your referrals ect to get it done so someone has screwed up, CALL and CALL till you get them to pay Pitt. I had the same surgery as you and never paid ONE CENT so you should not pay ONE CENT either!! DONT WORRY SOMEONE F****** up and you wont have to pay!! stay on top of them, and let me know if I can help

hugs
Darcie

Hey Jami:

Did you call your surgeon's office and see if they tried to pull their money back?   Think if they paid the surgeon, they would have to pay the hospital.  If you can't get this straightened with Tricare, I would call the NC Dept of Insurance and find out what your rights are.  Here is their website.  Good luck!

http://www.ncdoi.com/

Pam

 

Jami sweetie let me ask you a few questions.   Did you or the surgeons office ever recieve written letter that there was pre authorization and predetermination from Tricare that you would be or approved?  Or was it all verbally?   I think you can appeal it either way if you have dates and times and people you spoke with or have the actual letter from them.   If you need help to appeal this on the back end let me know I will try to help you as much as I can.

Vicki

I don't understand why the hospital would have given the money back after they received an approval from Tricare?  That's the part that doesn't make sense to me!!!