So Frustrated with my Insurance Company

hadderrie8
on 6/23/14 5:17 am

So I had my surgery scheduled for July 7th. We did all the pre-surgery leg work with the insurance. Every time either I or the surgery center talked to them they told them that they did not have to be a Blue Distinction Center. They even told them that last week just prior to me going for my final appointment with the surgeon before the surgery. We set the date for July 7th, I was starting my pre-op diet this morning when I get a call from the surgery center. My insurance company is now saying they do indeed have to be a Blue Distinction Center and they are not. I can't afford to pay $4500 out of pocket instead of the $143 out of pocket I was supposed to have to pay. If I chose to continue with that surgery center they would consider it out of network and the fees would be outrageous. So here I am been working on getting a date for 6 months having to start over with a different program in my area. My only hope is that they will take what I have already done and went through (nutritionist, psychologist, etc.) into account and not make me start completely from scratch. 

Cathy W.
on 6/23/14 5:32 am

How frustrating and disappointing. 

Another surgeon should take your pre-op tests if you select a surgeon before the tests become outdated. 

The good news is that you will be able to have surgery as they didn't deny you, just require you to go to one of their select centers. 

Hang in there and pursue your goal of having WLS.

Sarahlicious
on 6/23/14 10:27 am - Portsmouth, OH

Did you ask for the policy in writing where it states they have to be a Blue Center of Distinction...do you have a such a center close to you? If there isn't one in certain distance to you, they could have to waive that requirement. Ask for the proof, esp since you'd been told differently!

I have Lipedema and Lymphedema. I also have a passion for Obesity and Health Insurance Advocacy

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