insurance not covering my surgery

My insurance has failed to pay for my surgery 2 x and I am covered and was qualified for surgery. I have to file an appeal. They accept my premiums every month on time. Oh no, this will be covered, $26,000.00 I do not have (I had 2 surgeons do my sleeve). ugh isn't there always something?!   Not stressing, this will not bring me down. comments appreciated. Has this happened to anyone, you were told by your dr that you qualify and are ready to proceed to then find out your ins co. won't pay? Not gonna happen.

 

Did you not get insurance approval before having surgery?! If you did, you should have a letter that shows they approved you.

no  I didn't get anything in writing I just trusted my surgeon he said I was eligible and said let's move forward. Now, I did call my insurance company prior to the surg ( a recorded conversation and asked specially if I 1.qualify and 2. was covered by my insurance 3. spoke with my bariatric insurance coordinator and was told that it would be covered so, now I will fight with a letter of appeal. I spoke with my insurance company last thurs. and was told that the wording and diagnosis code wasn't recognized by my insurance. she said they want to see the words"bariatric surgery" rather than stomach reduction laproscopic. Called surgeons office gave them that info and they are so stupid telling me they can't change wording, the dr has to approve it. SO GET HIM TO CHANGE AND APPROVE IT WAS MY AGRUMENT.  oh the drama and this too shall pass or he will get $20 a month!

Good luck getting them to agree to $20/month payments for a $26k bill; without accounting for interest, it would take them over 100 years to get their money. Wouldn't be surprised to see collections get involved.

I know I obviously can't pay that little, I just frustrated that I trusted a verbal agreement and didn't get anything in writing, that's me, too trusting. I learned my lesson.

It sounds like you might be out of luck since you didn't get approval pre-op. "It will be covered" is different than actual approval. And you might find that collections or wage garnishment is involved since $20/month probably won't cut it with interest and everything. 

 

thanks, we'll see. Big lesson learned, trust nothing verbal, get everything in writing. ugh have a good day I know you are going through something right now. we are thinking about you.

Sorry, I'm confused.  It looks like you already had your surgery, and now your insurance isn't following through with payment?  If that's the case, did the insurance approve the procedure prior to your surgery?  If so, there may be an administrative hiccup (e.g., paperwork, needed insurance to dr consult)

If you haven't had the surgery yet:  It may be that you qualify for the procedure medically and in your surgeon's eyes, but that you don't meet the strict criteria explained in your insurance benefit plan.  (The plan is public, and you should be able to find a copy on the insurance website).  In those cases,sometime a surgeon to insurance company consult can get you over the hump (e.g., when the surgeon explains you have multiple nontraditional comorbidities, etc)

Best of luck to you.

WLS is not covered by all insurance policies.  In fact, many exclude it purposely.

Did you obtain approval from your insurance company prior to surgery?  If not, you will be on the hook for the costs.  It's not up to the surgeons to confirm your insurance eligibility, unfortunately.  They may tell you that you qualify based on your BMI or comorbities, but it doesn't mean your insurance automatically covers it.

Damn, sorry you're having such a problem with your insurance. Frankly I'm surprised they operated on you. I figured that the surgeon/hospital won't do any kind of surgery without prior approval first. Those people want to get paid & usually they want some kind of insurance that they will get their money for any services they provide.

Did you look at all that paperwork they make you sign b4 you got the surgery? Somewhere in that stack you might have agreed to pay them even if the insurance doesn't. You might be able to reach some kind of settlement with the hospital if your insurance still won't pay. You really don't want this bill following you around & screwing up your credit score, etc. Things tend to snowball if you don't get ahead of the problem. Good Luck girl!