Here is a Doozy for you.....

Hey my fellow OH'ers... I am beyond frustrated!!!!!! I started going through the WLS process in July. My surgeons office (A Bariatric surgery only clinic) verified that I was eligible for both Lap Band and RNY BEFORE my initial visit with the office. The surgeon's office called UHC and asked specifically for procedure names and CPT codes. We got the "ALL GOOD". I have completed all the work-up testing, missed almost 30 hours of work and have spent a lot of money- I get denied. Apparently, I don't have the rider on my policy for WLS!!! WHAT>!>??!??!?! They said I did,,,the best part of all??? They admit thay they did....Geeze...they even covered the work-up testing!!!! I have sent in an appeal letter stating that I should not be punished for their un-professionalism and mistake, This ALL could have been nipped in the bud back in July with a simple "nope- she is not eligible" I am asking for some advice, options, anything...I am sad, mad, and emotionally spent with this. I am not giving up yet,,,but I don't have a plan. HELP!

Unfortunately, I know all too well about stuff like that. I started this journey back in Oct 2005, and am no closer now, than I was then.  This site is wonderful, but it doesnt prepare you for denials.  I actually went to visit Enochs and Moran. They were good docs,, but the place was a doozy to find! Steve

Hello Kim Is this the infamous staff at Dr. Enochs office you're talking about?  Yeah, um, they have no problem taking your 500$, and telling you "all will be handled by our fabulously talented insurance specialists"  R i i i i i g h t I'm curious, did you get your money back? Or did they keep your 500$ and blame it on you?

We haven't gotten to that point yet- I still owe them $150, but I am not planning on paying it until I see what happens with the appeal- I am having serious doubts about  them. I am slighltly nieve (sp?) and I trusted them when they said that insurance lied to them, but I have to admit, I am wondering. Did you have them?? What happened?