UPDATED! Help! Surgery is Wednesday but I just got a call saying there was a mistake with...
Do you have something from your insurance company IN WRITING? Also, do not rely just on your surgeon's coordinator. Make sure you are following up with the insurance company directly. Also, what is your yearly out of pocket? Have you met that? Is that lower than the 50%? No matter what the deductible is, if your yearly out of pocket is met you are covered. If you are close to that you only have to pay what your yearly max is.
LapBand Weight 460 (2006) | Panni Removal Weight 200 (2008) | 3rd kid (2009)
Revision to RNY Weight 355 (June 2015)
Our policy states Bariatric surgery is only covered 80/20. I was prepared to pay the 20% for my surgery in July. All my claims have processed with insurance covering 100% even though they state it's 80/20. That's because we met our Out Of Pocket Max for the year. I owe $0 for anything related to my surgery. This carries over to all NUT visits, psych visit, each monthly visit, hospital charges, anesthesiology, surgeon and surgeon asst. I owed 0 for everything. (They hold the claims until insurance approves then submit all at once.)
This sounds like a huge member services dispute because the whole point of the coordinator is to verify your coverage and make sure everything is write. If I had everything in writing, I would be bugging the crap outta BCBS for them to fix it. In my case I have a 30% copay up to my max out of pocket up to 4k. I am planning to use my FSA and then the hospital and the insurance company have interest free payment plans to take care of me making monthly payments for the rest. Hopefully they will at least give you some decent options since it was their mistake not yours.
HW: 273 GW: 130 RNY - July 31, 2015 M1: 28 LBS M2: 11 LBS
UPDATE: TUESDAY at 1pm
My day started at 8am bright and early on the phone with my insurance co. and my Dr's office. Lots of tears, and about thirty phone calls have taken place. It was decided that I was indeed looking at about 10,000-15,000 dollars in bills from the hospital and $2,000.00 from my surgeon's office. I am faced with having to pay the $2,000.00 today before 3pm if I want to keep my surgery date.
Also, BCBS said that they were not responsible for anything even though they did give the wrong information to my Dr's office in July.....I cried.....I begged.....I cried more, but tried to hold it together. I asked to speak to the "BOSS" and she told me the same thing, so I cried and thanked them for their time. Their point was that they (BCBS) had given the correct information to my Dr's office in March so that cancelled out the "mistake" in July thus leaving me with the first 50% of the surgery cost. I even ever so nicely mentioned contacting the State Insurance Board/Com. Nothing helped!
I then called my Dr's office again and begged for the ability to make payments. That was a no. I then spoke with the manager and begged, and cried and begged some more. I got a very polite no, and care credit numbers and that kind of thing while the manager then tried to get me to just reschedule. I explained that there would be no rescheduling. If we couldn't make it happen today, nothing was going to change next week. I then called care credit.
I was approved for half of the amount I need. I cried, then pulled my self together and called my husband. While on the phone with him I was being called by a number I did not recognize. I didn't answer. I continued to talk to my husband and told myself that it just was not my time yet. I got off the phone with my husband and thought about stuffing my face with food to make me feel better but I stopped before ever taking a bite! I then went to my bedroom and had a real good cry. The kind I had been holding back all morning while on the phone.
Then my phone rang. I was surprised to hear Lisa's voice. Lisa is the very nice woman who works at the hospital. She is the one who broke the bad news to me yesterday. I had already spoken to her this morning and told her I would call her when I was 100% sure what I was doing. I know they are chomping at the bit to fill my space at the hospital if I cancel. I about started screaming! Lisa had called to say that the woman from BCBS had just called her since she could not reach me a few minutes ago. Apparently after speaking to me the BCBS woman started looking into my policy more. She had called to say that there was a chance that my surgery could be covered 100%!!!!! WHAT???? Apparently the wording in my policy was unclear and needed some investigating. HMMMM...okay, I will take it!
One hour passes and BCBS calls me back and is still looking into the unclear wording of the policy.
My phone rings again, an hour past the last phone call from BCBS. The woman says, you got it! The surgery is covered 100%!!! I scream! I am in SHOCK! She says she will call the hospital and Dr's office and inform them. I am still in shock! I don't know what happened and what changed and neither does anyone at the Dr's office. I am okay with that. I will be having surgery in the morning, and BCBS is covering the surgery 100% and I pay nothing.
The doctor's office said that they have everything documented and if there is a problem later on down the line after surgery they have their ducks in a row.
I am drained! I am so very happy right now! Thank you to everyone who prayed for me or sent kind words or advice. Thank you so very much! I am so lucky to have you all!
izzi
