Insurance Denial 6 months post-op???????????
I received insurance approval (Independence Blue Cross of Pennsylvania) for my WLS on Feb. 14, 2008. I had surgery on March 4, 2008. I am NOW (over 6 months after surgery) getting a letter stating that they are denying payment!! Is this possible???? I feel like I am suddenly in a nightmare. Of course, I will call the insurance company and my surgeon's office tomorrow, but this is insane.
Has anyone ever heard of this? Any advice? I'm ready to fight them tooth and nail, as I relied on their approval of coverage for the surgery. Thanks for your time.
Has anyone ever heard of this? Any advice? I'm ready to fight them tooth and nail, as I relied on their approval of coverage for the surgery. Thanks for your time.
Hi Vicki.
I contacted BC this morning. They are stating that they are now denying my claim due to my morbid obesity being a pre-exisiting condition! This after they specifically authorized coverage for my RNY WLS surgery due to morbid obesity!!! Their reasoning is insane! The guy I spoke with was very nice, and he couldn't understand it either. He began the appeal process for me, which was him basically sending a brief narrative for review. I was told it would be 14 days before I would have any further information, and we agreed that I would call him in 14 days.
I contacted my surgeon's office as well, to let them know what is happeneing and to see what assitance they could give. They confirmed that the bulk of my bill showed as having previously been paid by BC, and BC has not yet asked for any of the money back, despite the paperwork I just received. I was also told that they have another patient who is in the exact same situation, with the exact same insurance carrier. They could not give me that patient's name, but I gave them permission to give my name and contact information to that patient and perhaps we can present a united front. If this is a pattern, it is particularly problematic.
Vicki, I see in your signature line that you are an insurance guru. Any assistance you can provide would be very helpful. Believe me, I am well-prepared to fight this out, but I can use all the help I can get.
Many thanks,
Coni
I contacted BC this morning. They are stating that they are now denying my claim due to my morbid obesity being a pre-exisiting condition! This after they specifically authorized coverage for my RNY WLS surgery due to morbid obesity!!! Their reasoning is insane! The guy I spoke with was very nice, and he couldn't understand it either. He began the appeal process for me, which was him basically sending a brief narrative for review. I was told it would be 14 days before I would have any further information, and we agreed that I would call him in 14 days.
I contacted my surgeon's office as well, to let them know what is happeneing and to see what assitance they could give. They confirmed that the bulk of my bill showed as having previously been paid by BC, and BC has not yet asked for any of the money back, despite the paperwork I just received. I was also told that they have another patient who is in the exact same situation, with the exact same insurance carrier. They could not give me that patient's name, but I gave them permission to give my name and contact information to that patient and perhaps we can present a united front. If this is a pattern, it is particularly problematic.
Vicki, I see in your signature line that you are an insurance guru. Any assistance you can provide would be very helpful. Believe me, I am well-prepared to fight this out, but I can use all the help I can get.
Many thanks,
Coni
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