I need help...Gary do I need a lawyer?

I have been battling with my insurance company (bcbs of michigan) for the past three months. They have been telling me something different each time I call about pre authorization. They tell me its not required, then it is, then it isn't, then it is and now it isn't and that seems to be their final answer. They won't give me ANYTHING in writing. I have asked for my policy which they sent but of course it doesn't have anything in it about bypass surgery or not requiring pre-authorization.  I have called to talk to supervisors, the last one I talked to gave me completely different information than what I had been getting. They wont speak to me about certain things regarding the surgery and says my surgeon has to call. The surgeon calls but doesnt get much either, and we still can't receive anything in writing regarding their qualifications. And now since they are sure pre-auth is not required i can't get an approval letter or even a denial letter so that I can take other actions.   Today the surgeon's office basically said there is nothing else they can do, that I'm on my own and they will not do the surgery without pre-auth. They won't even talk about self pay or other options that they have because i have no denial either.  Today is my birthday and I am in tears. I'm trying to stay strong and fight but I don't know what else to do.

I'm sorry. My surgeon, my nephrologist, and my PCP are all helping me to fight the 6-month program rule that PacifiCare is insisting on, even though in CA it's not required. IMHO, you should contact a lawyer...just asking if you need one, or having them review your case, may not cost you anything. Secondly, I think you should contact your Insurance Commissioner there in your home state, and get them on your HMO's case. Call the insurance company again and ask them who you should CC your letter to that you are sending to the insurance commissioner. I wish you luck, and hope that Gary has a good answer for you, since I'm just a layperson fighting my own battle.

Dont you just love the telephone.  12 calls and 12 different answers.  You really need that handbook and the section on obesity surgery.  IN the meantime, keep up the diet just in case,