Dilemma...what would you do?

svelteNgorgeous
on 4/25/11 4:41 am, edited 4/25/11 4:43 am

So, I've done months of research. Chosen a surgeon. Booked a surgery date. Completed all the required evaluations. Lost 21 pounds in preperation. The day has arrived, I'm scheduled for surgery tomorrow.

Here's the problem, my insurance company has not made a pre-determination and will not have completed their review in time. The contact at my insco that I spoke with seems to think, based on her experience reviewing these matters, that my claim would most likely be paid when submitted. A pre-determination stating that would have been reassuring...but its not gonna happen.

Do I go ahead with the surgery and risk a financial tsunami if my claim is denied???

Could_It_Be
on 4/25/11 4:44 am

VSG on 06/22/11

How long will the pre-approval take?

I don't think I'd risk it
:/

bekahler
on 4/25/11 4:45 am - Parkville, MD

VSG on 10/14/10

wowza...that's a tough one!! Perhaps you can tell us what insurance etc so if someone else out there has the same they might be able to help you...

Im not sure I would be able to handle the additional stress..but thats me and I am a certified spaz.

I know when I got my bill I almost choked..I had prior approval and they still denied it the first go around...The bills totaled about 20k...

Good luck with such a major decision..has your dr office offered any advice?

"There are no Strangers Here, Only Unmet Friends" ~Helen Keller

Puppylovemommy
on 4/25/11 4:48 am - LA

Since I am cash pay, I don't have that stigma to be concerned with. My surgery is going to cost $13,600 but if I have complications it will be more. I CANNOT afford to NOT have it done!

Snigglefritz
on 4/25/11 8:24 am - CA

RNY on 08/23/11

I pray your surgery goes great and no compliaions comes up. I'm sure it will be fine, but I'll throw a little prayer in there for you too :)
Tammy

Puppylovemommy
on 4/25/11 9:49 am - LA

On April 25, 2011 at 3:24 PM Pacific Time, Snigglefritz wrote:

I pray your surgery goes great and no compliaions comes up. I'm sure it will be fine, but I'll throw a little prayer in there for you too :)
Tammy

Thanks Tammy!!!

Snigglefritz
on 4/25/11 10:32 am - CA

RNY on 08/23/11

Keep me posted it you can :)

jbskaggs
on 4/25/11 4:51 am - holt, MO

VSG on 03/19/11

Same for me- I paid cash and spent about $4500 on surgery.

If you want to fight the insurance and think you will win- then go ahead. But it is a gamble.

svelteNgorgeous
on 4/25/11 4:51 am

VSG on 05/17/11

The pre-determination takes 10-15 business days. It was submitted to the insco 4/19.

I have UNH Empire Plan for doctors and BCBS for hospital. My doctor charges about $20K alone plus the anesthesiologost and the hospital (Lenox Hill). I would not be surprised if the total tab for this came to over $50K.