HELP!!!! insurance and DR BULLCRAP!
So i was so happy june 15th to go to McKenna's office and start my 6 months! i have been so excited and trying to get my life straight and practice everything already and reading every book i could!
Insurance had told me and my husband that they coverd it! so we thought nothing of it, also because he has the best plan carefirst offers, so we go there with high hopes! only to get a phone call 2 days later from the office saying that our insurance wont cover it... ok that sucks... but we can fight it right? yes, we go and get answers, the only reason insurance wont cover it is because its not on the plan, which means my husbands work didnt check that as a part of it?
but we can still fight it right?
i have heard of all kinds of people on here that have fought it and have won, so the nurse said it shouldnt be hard, well guess what? they called my HUSBAND not even me from Dr McKEnnas office the other day and told him that they dont even want me to continue being seen by them unless i can pay cash up front for every visit???
i think this is bull**** for a dr that sits there and says he wants to help you...
now im stuck and have no idea what to do? do i just sit here and wait till march when my hsuabnd can have his insurance plan changed? and then start all over again with another dr? or what?
i need your advice everyone! i just do not know what to do, it feels like my whole life just crashed and i cannot cry anymore!
Thanks!
amy
Insurance had told me and my husband that they coverd it! so we thought nothing of it, also because he has the best plan carefirst offers, so we go there with high hopes! only to get a phone call 2 days later from the office saying that our insurance wont cover it... ok that sucks... but we can fight it right? yes, we go and get answers, the only reason insurance wont cover it is because its not on the plan, which means my husbands work didnt check that as a part of it?
but we can still fight it right?
i have heard of all kinds of people on here that have fought it and have won, so the nurse said it shouldnt be hard, well guess what? they called my HUSBAND not even me from Dr McKEnnas office the other day and told him that they dont even want me to continue being seen by them unless i can pay cash up front for every visit???
i think this is bull**** for a dr that sits there and says he wants to help you...
now im stuck and have no idea what to do? do i just sit here and wait till march when my hsuabnd can have his insurance plan changed? and then start all over again with another dr? or what?
i need your advice everyone! i just do not know what to do, it feels like my whole life just crashed and i cannot cry anymore!
Thanks!
amy
on my way to my WLS journey and cannot wait!!!!
Unfortunately, that is the process. Most doctor's will want you to pay as you go. I had to pay cash the entire 4 years of pursuing the WLS insurance will-o-wisp. Some of that was not reimbursed at all when I changed jobs. :/
Insurance can be bugger to fight to and drawn out over months. Get your ducks in a row and research research research. If your husband's insurance does not cover WLS now, it is highly unlikely any appeal will make them cover it at all. You might have to go through Self Pay or wait until insurance covers it. Been through that fight twice now. Maybe someone on this board has won that fight though. Ask around and see if anyone can help.
If you already know what you need to do to get ready (i.e. 6 month doctor supervised diet) start that to get the process going. Keep your receipts and if you have a FSA account put it on that (just keep a good detailed account of the charges as they are usually tax deductible). You can apply for reimbursements later. Or have them apply towards your deductible.
Insurance can be bugger to fight to and drawn out over months. Get your ducks in a row and research research research. If your husband's insurance does not cover WLS now, it is highly unlikely any appeal will make them cover it at all. You might have to go through Self Pay or wait until insurance covers it. Been through that fight twice now. Maybe someone on this board has won that fight though. Ask around and see if anyone can help.
If you already know what you need to do to get ready (i.e. 6 month doctor supervised diet) start that to get the process going. Keep your receipts and if you have a FSA account put it on that (just keep a good detailed account of the charges as they are usually tax deductible). You can apply for reimbursements later. Or have them apply towards your deductible.
not sure if this will help you or not, but there IS light at the end of the tunnel :)
I had wanted to have the procedure done for years, always to be told that insurance did not cover it.
Luckily I happened to have a conversation with the person that handles our coverage at care first late last year and she said the only reason it wasn't covered was that there wasn't a "rider" attached to our policy indicating it should be covered!! there was no extra charge to have the "rider" added - I just had to wait for our renewal for her to add the rider, and once that was done i was free to pursue the surgery.
Maybe you husband can talk to his HR department and see if they know anything about this? I would imagine that it would be easier to do if he works at a small company, but if you can get the rider added you should be ok. it might take a year for you to actually GET it covered if you have to wait for the renewal to process, but it's a place to start.
good luck!
I had wanted to have the procedure done for years, always to be told that insurance did not cover it.
Luckily I happened to have a conversation with the person that handles our coverage at care first late last year and she said the only reason it wasn't covered was that there wasn't a "rider" attached to our policy indicating it should be covered!! there was no extra charge to have the "rider" added - I just had to wait for our renewal for her to add the rider, and once that was done i was free to pursue the surgery.
Maybe you husband can talk to his HR department and see if they know anything about this? I would imagine that it would be easier to do if he works at a small company, but if you can get the rider added you should be ok. it might take a year for you to actually GET it covered if you have to wait for the renewal to process, but it's a place to start.
good luck!
Don't blame the doctor. Would you work at your job for free? If your insurance doesn't cover the procedure, you are essentially asking the doctor to see you for free until the insurance mess is hashed out--which could take months, years, or never.
Many of us have had to pay at least part of our costs up front, and have waited years for surgery with numerous setbacks. It's a sacrifice, but if you really want something, you find a way to make it happen.
Many of us have had to pay at least part of our costs up front, and have waited years for surgery with numerous setbacks. It's a sacrifice, but if you really want something, you find a way to make it happen.
"Fall down 7 times--STAND UP 8!"
Im sorry but i can blame and be mad at the doctor, insurance will not cover surgery but they cover every penny of me seeing this doctor, so i could be going and getting everything i need and waiting till i can get things in order and have my 6 months down with him but he wants to be a jerk and kick me out??? no thats wrong
Thank you about the rider, thats exactly what it is, his company did not check that as a coverd issue on the plan, he works for a big company here in maryland, and it wont be till March when he can get it added on, which if my dr wasnt being such an ass would only be 3 months after my 6 months would have been completed so it wouldnt have been so hard! but now i have to find another dr and start all over and wait till march when it can be added on and then hopefully everything is clear from there!
i just dont understand why the dr i was seeing didnt understand that insurance covers EVERYTHING about me seeing him, but will not do surgery till its added on to the plan! so he just kicked me out!
well thats 1 doctor im not telling anyone to see for ANYTHING!
Thank you about the rider, thats exactly what it is, his company did not check that as a coverd issue on the plan, he works for a big company here in maryland, and it wont be till March when he can get it added on, which if my dr wasnt being such an ass would only be 3 months after my 6 months would have been completed so it wouldnt have been so hard! but now i have to find another dr and start all over and wait till march when it can be added on and then hopefully everything is clear from there!
i just dont understand why the dr i was seeing didnt understand that insurance covers EVERYTHING about me seeing him, but will not do surgery till its added on to the plan! so he just kicked me out!
well thats 1 doctor im not telling anyone to see for ANYTHING!
on my way to my WLS journey and cannot wait!!!!
I know it can be really frustrating!
As for the 6 month diet, it doesn't have to be the bariatric surgeon that does it, in fact, my plan said it had to be a dr that did not do the surgery to supervise the 6 month diet. Of all dr's do you know who supervised it? my ob/gyn. Get going on your 6 month diet, you can get that out of the way and then 3 months later you will be ready for all your pre op testing and then your surgery date!
As for the 6 month diet, it doesn't have to be the bariatric surgeon that does it, in fact, my plan said it had to be a dr that did not do the surgery to supervise the 6 month diet. Of all dr's do you know who supervised it? my ob/gyn. Get going on your 6 month diet, you can get that out of the way and then 3 months later you will be ready for all your pre op testing and then your surgery date!
I understand how frustrated you are.
One thing to keep in mind, as far as the 6 months goes, is that it might not be your doctor "kicking you out" it might actually be the insurance company.
I had to have 6 months supervised before surgery would be approved. I had to go to someone in network and they had to be a "center of excellence". So, even if you do it now, it might not even count when it comes time for you to start the surgery process again. You may want to check with your insurance about that. I had some supervised time in prior to seeing Dr Mo, but it didn't count because I wasn't in a "pre surgery" program. Care First, depending on your plan, can be a little tricky to navigate.
I know you're angry that you have to wait until the rider is attached to your policy and all that good stuff, but I swear it goes by SOOO quickly!! As they say, anything worth having is worth the wait, right?
You should take this time to lose as much weight as you can. The less you weight for your surgery date the safer the surgery will be :)
Feel free to email me if you want to vent any more - I'm more than happy to share my experiences with Care FIrst
One thing to keep in mind, as far as the 6 months goes, is that it might not be your doctor "kicking you out" it might actually be the insurance company.
I had to have 6 months supervised before surgery would be approved. I had to go to someone in network and they had to be a "center of excellence". So, even if you do it now, it might not even count when it comes time for you to start the surgery process again. You may want to check with your insurance about that. I had some supervised time in prior to seeing Dr Mo, but it didn't count because I wasn't in a "pre surgery" program. Care First, depending on your plan, can be a little tricky to navigate.
I know you're angry that you have to wait until the rider is attached to your policy and all that good stuff, but I swear it goes by SOOO quickly!! As they say, anything worth having is worth the wait, right?
You should take this time to lose as much weight as you can. The less you weight for your surgery date the safer the surgery will be :)
Feel free to email me if you want to vent any more - I'm more than happy to share my experiences with Care FIrst
Amy-
I'm sorry to hear about your troubles, but you should try Dr. Gorman's office again... see what their policy is about insurances and/or paying upfront.
Summit Health is a wonderful health system, and I'm sure they will be willing to work with you, regardless of your situation.
Hang in there!
Cyndi
I'm sorry to hear about your troubles, but you should try Dr. Gorman's office again... see what their policy is about insurances and/or paying upfront.
Summit Health is a wonderful health system, and I'm sure they will be willing to work with you, regardless of your situation.
Hang in there!
Cyndi
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