Insurance Approval workaround

You'd be surprised what some doctors will risk with respect to insurance fraud. When my dad died from prostate cancer in 2013, a doctor who was supposed to give him radiation treatments to control the bleeding when the cancer spread to his bladder suddenly charged medicare for the full 10 treatments, even though he DIED before even receiving the first one and her listed dates for the treatment were after the date on his death certificate. We called her office first and was told "we can generate documents to show he received treatment, who do you think medicare will believe - a doctor or you?"

My response was that they will believe the death certificate and an affidavit from the funeral home regarding date of cremation before any document she falsely generates after the fact so unless she is claiming to have performed radiation treaments on his ashes, she should reconsider. I then called medicare and reported the fraud. For the next year my mother received bills from doctors my father had never even seen asking for payment for what medicare didn't cover claiming to have treated him even 6 months after his death - again, doctors we had never even heard of let alone seen! Reported them all. and yet, they are all still practicing.

I am not sure if this will help but in my case the insurance denied it and again in the appeal. My Surgeon completed the endoscopy and found the polyps in my stomach were overtaking the stomach, the GERD was horrible, and also were the cause of my having to take B-12 shots the rest of my life as they were not allowing the B-12 to absorb. Because of this and a few other issues he submitted it for a In-patient General Surgery. Coded as Partial Stomach removal due to severe GERD and the other issues. (All issues were honestly true). It is the same surgery but is a general rather than Bariatric. It was approved and I had the surgery last week. I follow all guidelines as if it was called a Bypass.

Like I said, this was my case, but maybe there may be another legal way for you.

Good Luck