insurance not covering my surgery

As the others said, this doesn't make any sense.  I cannot imagine that the surgeons office even scheduled the surgery (let alone performed it) without getting approval from your insurance company, especially since the surgeon's office knows full well that a lot of insurance policies do not cover weight-loss surgery!

You said that they didn't pay for it "2 x".  What does that mean?  What kind of communication do you have from them (and what is their given reason for refusing to pay it)?

Is the $26,000 the full cost of the surgery or is it some portion that they will not pay? Somethign just doesn't add up.

Lora

my dr's office policy is that there is always a second dr in the surgery. so they were each charged $13,000.

If the 26,000 is for the surgeons, how much do you owe the hospital?

stuff like this is not unusual  ,my hubby got a refusal letter the Friday before he had life saving  surgery for cancer on monday

 the surgeons office got on the phone with the insurance company after 5pm and found out a wrong digit in the procedure  code was the problem and got it fixed 

 keep fighting , bankruptcy is also an option , I know a person that lost there house to a non covered medical procedure and could have went bankrupt instead and keep there house with the same credit problems

Yes, this exact thing happened to my husband.  He met all the qualifications and his insurance company decided at the last minute NOT to cover it because his high blood pressure (a pre-existing condition) was controlled by medication.  Basically, they pulled a fast one on us at the last minute.  But insurance companies always tell you in writing if they will cover something or not and hospitals always verifiy coverage ahead of time.  I know this because I work for a hospital. 

My surgeon was smart enough not to schedule the surgery until after he got a letter from our secondary insurance carrier saying that they would pay for this. We still spent the last 12 months going 'round and 'round with both companies but BCBS finally paid the hospital bill to the tune of $31,000.  That was just hospital charges, which didn't include anesthesia or surgeon fees.  

If you proceeded with a surgery without written verification from your insurance company that you were approved, you may be well and truly screwed.  Because all insurance companies make it crystal clear in the outline of benefits that they will only pay for non-emergency surgeries if it is cleared with them ahead of time.  Regardless of what your doctor says.  Doctors don't make the rules on these things - insurance companies can and do.  

Good luck - but be prepared for a long, hard fight on this one.  

I am very curious as to how this actually happened. I cant believe a respectable surgeon would operate on you without ins approval or payment in hand. My surgeon wouldn't even give me a date without ins approval in hand. Now they did take care of getting it for me. I didn't have to do anything except bring them paperwork that they requested. And my ins company mailed me a copy of the approval for my records. I hope you get this resolved because $26k is a lot of money.

Just as an aside, my surgeon billed the insurance company something like $10k but the final payment from BCBS was right around $1100.  $13K for the surgeon fee is ridiculous.  My insurance covered me at 80% and I think between me and the insurance, we paid the doctors, hospital,  etc, about $22K for my surgery.  The hospital got most of that.   My surgeon offers a VSG cash option of $15K all inclusive.  A friend in NW Arkansas says he has be quoted $12.5K all inclusive for the VSG.

Costs can vary a LOT between doctors, different parts of the country, etc. Here in Arizona, my surgeon quotes $24k for self-pay VSG.

What Julie said.  The surgeons I work for here in Ohio charge $22,500 for self-pay VSG.  They charge $14,000 for self-pay lap band.