Just Wondering

What happens if you self-pay and then insurance comes through? First of all, I cant really self pay at this point, but what if I somehow found it, paid for the surgery, then my insurance decidded to pay? I am still appealing (I'm in like appeal #3, I think), but also looking into whether I can handle taking a loan...dont think I can, but maybe. My question is two fold... #1..Would I just pay and then the insurance company would reimburse me later? #2..I have been appealing a request to have surgery at OSU, but if I self-paid, I would go to Dr. C (cheaper and just as good reputation). If insurance ended up paying (after I paid myself), would I not get reimbursed cuz I went somewhere different than what was in all my paperwork? Isurance companies are just plain evil! Why is this such a game?

Dear SoNot Skinny: Insurance companies require pre approval for the procedures which is their agreement to pay. If you pay first they have no obligation whatsoever to reimburse you. My suggestion would be to wait for your appeal if you can. I agree, they are evil. I wish you the best. Sincerely, Calvin Selwyn, M.D. Assistant Professor of Surgery UC Center for Surgical Weight Loss [email protected]

I was afraid of that.

Hi Dr. Selwyn... Havent seen you post here in a while.....It's good to see you on here again Sherri

who is your insurance company? and what reasons are they denying you for?

Hi Susan...I have United Healthcare and there is an exclusion in my policy. My husband owns the company, but we cant get a rider or add WLS to the policy because his business is not large enough. Have to have like 150 employees. Same reason we cant find another insurance company to switch to that has WLS as a covered benefit. Only the big ones get it. I've looked at approx 10 new policies trying to find one to switch us to, but none cover for companies that have less than like 150 employees.

Gosh .... I am so sorry

Sherri: Sorry it's been so long. Dr. Gersin has left me so I have assumed all of his practice as well as moving a large part of the practice to Christ Hospital as well as maintaining the University Pointe Hospital, I've also started about 7 new research projects and formed a bariatric research team. I have also began offering Lap Bands since the recent study came out. Otherwise not much is going on, LOL,... I'm doing well. I'm also glad to hear from you. I just thought I'd look in and see what was going on with the Ohio board. Talk to you soon. Sincerely, Dr. Selwyn