WLS covered under plan last year but not now
After calling my insurance last year to make sure WLS wasnt excluded.I started last July doing the 6 month weight loss classes. I completed evrything in Dec. WLS was a covered benefit last year with my insurance (IBX). On Jan 3rd I had an appointment with surgeon and as it was a new year I wanted to be sure it was still covered. I was told that it was by a rep at company. So I continued on with appt with surgeon and also with nutritionist and psych consult. Insurance paid all of these. All of my paperwork was sent to insurance and I got a pre-cert #. Ten days later (feb 17th) while I was waiting for decision I went on their interactive site and by chance saw that WLS was now excluded from my policy. I thought that it couldnt be true so I called company and was told that yes it excluded. A few days latter I received a letter denying the surgery. I complained to a supervisor and he said he would listen to recording of phone call (they record everything). He called and left a voicemail that I have saved that states that the rep did say it was a covered benefit. He also said that IBX would be responsible for all services thru Feb 17th when I called and "educated " myself that it is not a covered benefit now He said I could appeal. My first appeal was denied also. IBX apologized for the "incorrect information" but said WLS is excluded. I tried to tell them that this "incorrect info" is what made me continue with the process and pay out copays, miss work etc.s I'm in the process of a second appeal. I have a conference call with the board this thurs in morning.( i could attend but I'm in MD and they are in philly and when I dont work I dont get paid). This whole thing makes me nauseous and gives me a headache everytime I think about it. I feel like they slapped me in the face. I did everything IBX required me to do. I dont have much hope for thurs if they are going to stick with the exclusion argument. Help!
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