EBMS Approves then denies surgery

My wife went to EBMS, her insurance carrier and they said they would cover it if she went through the proper procedure (7-29-06). She went to her doctor and had a physical done, also they required er to see a psychologist for an evaluation (8/10-24/2006. She did all this then they approved her (8-29-2006). We were going to get it done out of state so we were planning for the trip. In the middle of planning er doctor and her HR dept. get a notice that they approved it by mistake(9-21-2006). How can an insurance company play with peoples feelings like this.  She was all pumped up about getting the surgery and then they took it from her.  I was wondering if anyone else has happened to them. I love my wife and it saddens me to see her being played with by some big insurance company.

What was the reason for them denying it now?  Do they cover it and have requirements or is it excluded? Find out exactly what they cover, and also, whether the policy changed at all over the past month.   Also, file a complaint with your State's Insurance Department against them.  You should appeal and fight it as well, but definately file a complaint.  That is just so wrong

My wife called EBMS in July to see if the surgery was covered.  EBMS said no. My wife was told by her Human Resources Department to have the doctor write a letter of reconsideration of medical necessity for pre-determination.  The doctor received a request from EBMS for the necessary criteria required for determiniation of medical appropriateness of bariatric surgery for morbid obresity.  EBMS requested letter of support of the surgery from the PCP stating history, attempts at weight reduction and current health status, Blood tests, EKG, and psychological evaluation.  EBMS requested items were submitted 8/24/06 and on 8/29/06 the doctor received a fax from EBMS stating the surgery had been approved.  My wife received an approval letter dated 8/30/06 that these services would be considered an eligible expense subject to plan provisions, UCR and eligibiltiy at the time charges are incurred.  Surgery date has been set for Oct. 31, 2006.   On 9/21/06 The doctor's office received a phone call that EBMS had the surgery had been approved in error. They admitted to my wife's HR departement they made the mistake.  The HR department is requested EBMS to look at the surgery as an alternate care provision.   EBMS still hasnt made a decision and the surgery is scheduled in 3 weeks.  Should we be prepared to write the appeal letter?

OMG!   This EXACT thing just happened to me!  I went through all the required testing, received an approval letter and then a surgery authorization letter, and ACTUALLY WENT INTO SURGERY ... the surgeon cut me open and then decided not to do the RNY because he didn't like the way my liver looked, so he did a biopsy, closed me back up and sent me to a liver specialist.   I then went through all the specialist's tests & procedures and he cleared me to go ahead and have the surgery done.   I went to a different surgeon (the original one dismissed me as high risk) and after putting me through more tests decided it was safe to proceed with the surgery.   All we needed the ins. co. to do was transfer the benefits to the new surgeon.   This time they denied it, stating there was an exclusion in our policy, and that it had been approved the first time in error.   And they won't budge!   I'm at a total loss.   I sent an e-mail to Gary describing this and asking his advice, so I'll be very interested in what he has to say.   I can't believe this happened to your wife too ... I thought this was just a once in a lifetime piece of really rotten luck for me!!   I sure hope we can find a solution for both of us.   Tell your wife I know EXACTLY how she feels ... except that I also have a 5-inch scar to show for my "mistake." Deborah in Texas Aetna PPO