MY SURGERY NOT COVERED??? OMG!!!! LONG
If I remember correctly from working with insurance and billing - the insurance company doesn't get a refund check from the hospital, they just withhold on future payments until the difference is made up. At least that's how it worked years ago. Say they were making payments to the hospital for other patients and the total they were going to pay on other surgeries, etc was 144,000. Well Tricare would only send the hospital 100,000 and with hold the 44.000 - forcing the hospital to collect the 44,000 from the person denied. Make sense, not really but that's what they used to do.
Hopefully you have someting in writing from them saying the surgery was approved - and sometimes they still have a disclaimer. Do you have access to policy details, maybe online, showing how WLS is covered and under what conditions?
Keep us posted.
Hopefully you have someting in writing from them saying the surgery was approved - and sometimes they still have a disclaimer. Do you have access to policy details, maybe online, showing how WLS is covered and under what conditions?
Keep us posted.
Highest/Surgery/Current/Goal
250/241/139.5/125
I have a new philosophy, I'm only going to dread one day at a time. Charlie Brown
Jami,
I hate your going through this. They can't make you pay all of it up front. They have to take payments but what it might do to your credit I can't say.
Unfortunalty, before I had my surgery last year I did watch a program, don't know if it was night line or Good Morning America, but this does happen and few people know that this can and the Insurance companies can do this. Sorry. I sat on needles for months waiting for a letter after surgery. It is like a final review or audit of your case. I wish I still had my approval letter because I do remember the wording from NCBCBS that would make you think it was a final approval but if I hadn't seen this program I would of thought thats it. But after seeing the program it was clear that it could come back on me. It's all in the wording and also in your Insurance packet that gets sent to your Husband every year the policy is renewed. I guarentee you it's not in bold or someplace you'd see it.
One of my biggest rants is Insurance Companies are one of the biggest Fraud rings out there/ CROOKS!! They should be investigated heavily along with the oil companies, cigarette companies and Soda companies. But they have such good lobbyist, sponsor thousand of charities and events that no one wants to step on there toe's or have it found out the hand to pocket connections.
You may end up having to get an attorney but dig out your Insurance packet and start reading. Send the Hospital a payment even if it's $20 dollars. They can't force you to pay it in one month. I have been sending $30 to $50 dollars a month on mine and they are fine. Does the full amount cover all fees or is this just the hospital only?
It is still a blessing that you were able to have this surgery!! It has help save your life and made it better no matter what the out come is.
You'll get through this.
I hate your going through this. They can't make you pay all of it up front. They have to take payments but what it might do to your credit I can't say.
Unfortunalty, before I had my surgery last year I did watch a program, don't know if it was night line or Good Morning America, but this does happen and few people know that this can and the Insurance companies can do this. Sorry. I sat on needles for months waiting for a letter after surgery. It is like a final review or audit of your case. I wish I still had my approval letter because I do remember the wording from NCBCBS that would make you think it was a final approval but if I hadn't seen this program I would of thought thats it. But after seeing the program it was clear that it could come back on me. It's all in the wording and also in your Insurance packet that gets sent to your Husband every year the policy is renewed. I guarentee you it's not in bold or someplace you'd see it.
One of my biggest rants is Insurance Companies are one of the biggest Fraud rings out there/ CROOKS!! They should be investigated heavily along with the oil companies, cigarette companies and Soda companies. But they have such good lobbyist, sponsor thousand of charities and events that no one wants to step on there toe's or have it found out the hand to pocket connections.
You may end up having to get an attorney but dig out your Insurance packet and start reading. Send the Hospital a payment even if it's $20 dollars. They can't force you to pay it in one month. I have been sending $30 to $50 dollars a month on mine and they are fine. Does the full amount cover all fees or is this just the hospital only?
It is still a blessing that you were able to have this surgery!! It has help save your life and made it better no matter what the out come is.
You'll get through this.
Beginning weight: 284
Surgery weight: 251
Current weight: 149
Hi everyone!! THANKS SO MUCH for all the replies, the support here is beyond words!!
No I have not heard anything back yet, the lady at Tricare and I keep playing phone tag, but she is suppose to call me today after 3:30 to tell me what she found out!!!
TO answer a few questions, I got APPROVED by Tricare for my surgery, about a week before my surgery!! The surgeon has the approval letter!! They will not do the surgery without the approval letter!!! Also we are an active duty military family so we have Tricare Prime and this procedure IS COVERED 100% .... I know several people who have had this surgery and there were not questions whatsoever, Even our very own Darcie!! I want to think that someone put in a wrong code, because the lady at the billing said it was filed as "Morbid Obesity" and Tricare does not cover that!! So if it was filed as OBESE then it would be different?!?! I don't know, i guess i will just go with the flow and know that everything has to be okay in the end and hopefully just a typ-o!! My husband has been in the Marines for 12 years and Tricare is the military's Insurance....we have NEVER had a problem before!! *SIGH* I suppose that is why they always say " NEVER SAY NEVER"
Anyways thanks again to yall and i will certainly keep you updated!!! JAMI
No I have not heard anything back yet, the lady at Tricare and I keep playing phone tag, but she is suppose to call me today after 3:30 to tell me what she found out!!!
TO answer a few questions, I got APPROVED by Tricare for my surgery, about a week before my surgery!! The surgeon has the approval letter!! They will not do the surgery without the approval letter!!! Also we are an active duty military family so we have Tricare Prime and this procedure IS COVERED 100% .... I know several people who have had this surgery and there were not questions whatsoever, Even our very own Darcie!! I want to think that someone put in a wrong code, because the lady at the billing said it was filed as "Morbid Obesity" and Tricare does not cover that!! So if it was filed as OBESE then it would be different?!?! I don't know, i guess i will just go with the flow and know that everything has to be okay in the end and hopefully just a typ-o!! My husband has been in the Marines for 12 years and Tricare is the military's Insurance....we have NEVER had a problem before!! *SIGH* I suppose that is why they always say " NEVER SAY NEVER"
Anyways thanks again to yall and i will certainly keep you updated!!! JAMI
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