It's been denied

My friend just had surgery yesterday. She received a denial first, but the surgeon was able to gain approval upon appeal. It sounds like this isn't unusual with some insurance companies.

As the others have said hang in there, many people get denied at first. I think the insurance companies just want to see who is willing to fight for it. I hope all turns out well for you.

In my research in fighting for my knee surgery, I found out that they reject a huge number of first requests, just because most people won't fight it, and they save money that way.

I wish to heaven I could figure out how to monetize it, because I perversely enjoyed filing my appeals and making the insurance company eat it in the end. I drowned them in paperwork (over 300 pages with exhibits A - AD for each of FIVE appeals) and at the point I started citing U.S. Federal Regulations and State legal codes they'd violated in the appeals process, they all of a sudden approved my surgery. If I could figure out how to make money at it, I'd love doing it for a living.

Take a course as a paralegal and/or search for Anna Von Reitz and Winston Shrout I am not associated with them in any way,but have been following both of these. They have some ways to get around all kinds of things.

I was in paralegal training, and used to work as a Legal Secretary (how I know how to structure the documents). I'll do some searches for those guys because it's of interest to me. But monetizing it is problematic because all you can force from the insurance company is to pay for the procedure, even if you end up going to court. If they're self-insured they're protected under ERISA, and to take them to court you have to do it in Federal court, and the plaintiff is specifically barred from seeking anything other than the procedure, and only in about 1/2 of the cases where the plaintiff wins will they even get reimbursed for legal expenses, because that's up to how the judge interprets the ERISA wording about remedies. So someone fighting to get a medical procedure done won't have cash to pay someone to fight it, and there's no remedy to get money back from the insurance company to pay for the fight itself even if you win.

If I win the lottery, I'll probably open up a pro bono shop doing this kind of stuff just to stick it to the insurance companies. LOL.

I love how you stuck it to the man!?

It shouldn't be naive to expect the insurance company to be consistent about things. The doctor's office at this point for the OP has been putting in pre-authorization requests and finding out about the insurance's requirements pre-op and the insurance company has been approving all of those or the office would have already talked to her about self-pay. To pull the rug at the last minute is a crappy thing to do, but the insurance companies aren't interested in consistency, fairness, or even providing the service they have contracted to do. They are only out for a buck and don't care who they harm, maim, or kill in the process.

Exactly! ll about the money..

While I do not think I was naive...i do think there is a silver lining. I got really sick Monday and I think this was the way it was supposed to happen. I am still not happy with the reason given but will use that to my advantage.

Thanks for the support!!

It was indeed canceled but have an appointment on Jan. 4th with my surgeon. We shall see what comes after that. I intend to fight for this. One would think that someone who has good "numbers" consistently would be a good candidate. lol