In need of insurance knowledge fast!
I need help FAST from anyone who has been in this situation or may know insurance laws. I went to a lap band seminar Last January. Since then I have been in the process of it all. The conciliation, the group meetings, the nutritionist. In July they submitted to my insurance company. I had Meritain Health. It was denied..... of course. The bariatric center is the one who notified me in August telling me the insurance denied it. I waited to get the official insurance letter so I would know why they denied it so I would know on what basis to write my appeal letter. I waited and waited, finally after 3 weeks I called and told them I never got a letter of the denial and could they please send one out to me. two more weeks went by and still nothing so I had to call again. In September I finally got my letter. I wrote my appeal and sent it off. I waited for 2 or 3 weeks, heard nothing so I called. The insurance company told me they never received the appeal so she had me fax it to them. I waited another 2 weeks, heard nothing so I called.......a decision had not been made yet. I waited another week and called back......finally I got approved!!. I had my final consult with the Dr. on November 30th. I also had my required physical on the 30th. The next two weeks I had appointments to their exercise trainer which is a requirement and during that last visit, they gave me my pre op date for January 3rd and a surgery date of January 8th.
My Crisis - I just found out that the company I work for is switching to a new insurance. As of today 12-31-07 I will no longer be insured by Meritain Health. I don't have the new insurance info in front of me but I believe it is with Blue Choice. I called both insurance's today and now it seems like I wont be covered. Meritain says I wont be covered because I am no longer insured with them and Blue Choice says I wont be covered because they don't cover any weight loss surgeries. My surgery date is a week away and I have gone through so much to get here and now it seems like its all been for nothing.
Is it possible that someone can get so far into a process and then be halted? Do I have any legal rights? If I have gotten this far in the process, shouldn't one of the insurance companies be obligated? Please, if anyone has any solid advice of who to call or what to say or anything please let me know. Ive been on the verge of crying since I found out today. It makes me mad because if Meritain, had sent out the denial letter in a timely fashion, had they not lost my original appeal letter, and taken 3 to 4 weeks each time it was submitted to decide if they were going to approve it or not, I wouldn't be in this situation of a insurance change over.
Yeah...I think you are out of luck, I am afraid. :( I do think it sounds as if they did it on purpose, too...
Duodenal Switch hybrid due to complications.
Click! > DS Documents ~ VitaLady.com ~ DSFacts.com ~ OH DS FB
Click! > DS Documents ~ VitaLady.com ~ DSFacts.com ~ OH DS FB
Oh I am so sorry this happened to you. I was afraid this would happen to me, our company was sold on Oct 31st. Fortunately they kept the same insurance so I'm still good to go.
Maybe you can talk to someone in the benefits department of your company and they can help you. As a previous responder mentioned, many times the lack of benefit coverage is dictated by the employer so see if you can get them to change their policy.
Good luck!
Debbie
Thought Id share my good news. I found out today I will be covered so I am all set to go to pre op tomorrow. Its strange and a miracle how I ended up speaking to the top person on the ladder. Within 10 minutes of faxing her my approval letter from the old insurance company I received a call from the new insurance company letting me know that a mistake had been made and I would be covered. I did tell her that the reason I was calling was because I had called my state representative last night and he had called me back this morning after speaking with the state bureau of insurance and the bureau of insurance needed some information. I don't know if that had any influence on the fast action or not but I'm just grateful that everything got settled so quickly.
Oh man, that much be such a relief. Congrats!
Duodenal Switch hybrid due to complications.
Click! > DS Documents ~ VitaLady.com ~ DSFacts.com ~ OH DS FB
Click! > DS Documents ~ VitaLady.com ~ DSFacts.com ~ OH DS FB
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