Insurance question!

Hi everyone!

I had RNY back in 2009.  I have a new insurance company and they are denying my follow up claims.  I was seen as my surgeons office this year due to bile reflux.  I had several appointments, an xray and scope done.  They are denying all the claims since they had not approved my original surgery.   

Does anyone know if this would fall under a pre-existing condition? I am following up on several different ways to appeal this.  Just wanted to see if any one has experienced this or knows!  

Thank you! 

Dawn

My understanding of 'pre-existing condition' is that a carrier cannot deny you current coverage because of it ...... But they do NOT have to pay claims caused by it.

So, if your current insurer does not cover bariatric services, they don't have to pay for conditions caused by prior bariatric treatment.

I could be wrong ... Have you asked your HR rep or read your individual policy?

Yes, I called the administrator as one of the roads I am taking!  Thank you! 

Good luck with the appeal.  Next time go to a gastroenterologist. 

Sounds like any claim from a weight loss surgeon is automatically not going to be covered.  Bile reflux is from not having a pyloric valve so it may not be possible to get your new insurance to cover it.

If you are going to be stuck with that insurance you will want to put money into a health cafeteria plan to cover those expenses. 

Thank you!  I did forget to mention, they do cover Bariatric surgery.  However they didn't approve me to have that original surgery. 

I hope that helps with your appeal.

Have you contacted the insurance company and asked them why they are denying your claim? It could be something simple as the wrong CPT codes used in the billing process.

Insurance companies will try to deny claims over the smallest things.

Can't find my reply! Hopefully this isn't a second one!  Yes, I have contacted everyone involved and trying different ways of approaching! Keeping my fingers crossed.  Ultimately I can appeal as well! 

I was self paid for RNY in 2008.  I had some issues since, but you can't ever be 100% that theses are related to RNY and that without RNY I would not have tho. 

I make sure my doc do not put RNY as a direct cause... And no doc in right mind will ever tell me that my issues are only , and exclusively due to RNY.  I had no problem with treatments for acid, GB, abdominal issues, Food allergies..etc... 

You doc office need to decide them - unless they are willing to put a letter to you that they are know with a 100% conviction that you issues is exclusively and only related to RNY..

If they do - get the letter notorized and sue the RNY surgeon... (the last one is a joke) 

I have my PCP and specialists deal with any health issues.  Noone can then attribute problems to RNY, going to your surgeon just gives them an opening to deny.