X-Post Insurance: 2010-Exclusions & Limitations

 Please, please tell me that it is still a possibility for me to have my revision!!!!
Always nice to have a "fresh set of eyes" since I am so emotionaly involved, I might be thinking the wrong thing!!??

This is for my secondary insurance, through my husband.  My PRIMARY insurance is WORTHLESS when it comes to anything weight related.  (my company is self-funded)

I am still working on getting a pre-approval for a revision from the RNY to the DS with DR. K's office in California.  (any more details will bore you, so read my October 2009 blog for more info)

So, here is the wording in the new booklet which I just received in the mail this week:

(Under the Exclusions & Limitations portion in the booklet)
*Services which are primarily for weight-loss (except surgery for morbid obesity which has received prior authorization from the Administration Office)

This portion is under Surgical Services:
Surgical services for medically necessary surgery when received in the hospital, at the doctor's office, or elsewhere.  Charges for an assistant surgeon will be covered at 25% of the allowed amount for the surgeon's fee.

So, with any luck...... I will be working on getting my 2nd submittal in the works, and off to the insurance companies (Just wish we could skip the KNOWN denial of my primary insurance & go straight to the secondary.... oh well)


-Jamie in Alaska

Hey Jamie,
I had a denial, an approval that hours before the surgery became a "partial" approval.  On my pre-op day (after 3 days of being on liquids, etc) I was sitting in Dr. K's office trying to call the company, the insurance,  anyone who would listen.  Of course their offices were all closed down and I was already over time with taking the pre-surgery bowel cleans AND picking my hubby up from the airport.  Dr. K said it was my call but neither of us felt very positive.  .....  I finally started my cleans around 11 pm (bad bad idea!) and was up all night.  Got to the hospital on time and the surgery unit was ready to hook me up and get me ready for surgery.  I was like, "wait" I'm not sure I can really have this today!!!!  ......  Dr. K called just minutes later, said he'd gotten up to start calling my insurance at 5 a.m. (Eastcoast company) and had just hung up with a medical top dog who gave hime his "word" that I would be compltely covered.  Sooooo...i jumped into surgery completely trusting some guy's "word"!  Dr. K seemed very convinced that all would be well and I totally trust him!

Not only was everything fine (yet to see the bills though) but the insurance guy actually called Dr. K personally the next morning to ask how I was doing?!!  WHAT?!!!

Nothing like your situation except the drive to "get r done" and have faith....be pro-active and stay teamed with a surgeon that will have your back and go to batt for you!

Good luck sweetie pie!  You're in my prayers!

Joyce,

Thanks for the words of WISDOM!!!  That means ALOT!!!  



Happy healing
-Jamie