Vague Insurance Letter

I posted this on theVSG board, but realized that I might do better in posting it on this board.

Here goes....

I just went to the mailbox and my approval letter is here. But ....Can insurance companies be any more vague? Over the phone I was told by the UHC rep. that I was approved for the Laparoscopic Vertical Sleeve Gastrectomy...code 43843..... now here is what the insurance LETTER says:
"We received your notification for coverage of bariatric surgery for Connie Brown. This health care service is available for benefits  under the terms of the Raytheon Company health benefit plan.

Please be aware that the information in this letter does not guarantee payment or represent a treatment decision. Payment is based on the terms of your plan and patient eligibility when the services are received. All treatment decisions are made between the patient and the treating physician."

( then a bunch of other wierd stuff)

How vague is that? How do you even know (other than what I know was submitted, and what I was told over the phone)... if they are even talking about the right procedure OR code?

Wow. What a pain this all is!

Can anyone decipher this and tell me what they think?

I think it's similar to your insurance card saying "this is not a guarantee of coverage." In other words, they have to check for coverage the day of the service. Anything can change between now and then, you could quit your job, for example.

If your surgery is being done as an inpatient admission, then they would have given an authorization number for the surgery.  Call them back and ask for the auth number. 

I received the same type of letter from my insurance company.  I gave them a call and they explained to me where it made sense.  They said since my policy is a PPO, I don't require pre-auth except for a very few things, mainly prescriptions.  Inpatient care does require certification.  If you don't get it, then they will pay less.  She said that what they mean with the vague insurance letter is that I've been certified to have the surgery ... basically it is covered for me .... as long as I stay within the guidelines of my policy.

I know...it still doesn't make sense but both the insurance company and the surgeon's insurance person said not to worry.  It was basically an approval

I am waiting for my insurance company to respond... the paperwork was all submitted last week.  But I understand your issue, they all do that... telling you something is covered but there is no guarantee of payment.  You know of course if you quit your job or something happened to affect your insurance coverage, that makes sense but the vagueness is scarey to me.  It's like they can change their minds or something.  I feel like asking, so what does guarantee payment?  It should read, payment is guaranteed as long as you stay within the guidelines of your insurance coverage which are "insert text here."  That would make me feel better. 

Thanks for all of your help. The way it played out was.... I was told that this letter was only a precertification letter, verifying that I had coverage for bariatric surgery (not a specific kind), and that it was not the approval letter. I was told the approval letter was also behgin sent out, and would definitley have the CPT ins. code on the letter.


So..........the approval letter was sent to the surgeon, but I neveer get a copy of it, alothough I was told I would. But the surgeon's office did confirm that they had received it..... like a week after the first letter was sent out.

Wierd, but done. (Such a long story... uggghhh!)