Question:
What can I do? approved by mistake

my insurance approved both my husband and I for lap rny back in July. Our surgeries were already set up. My husband goes in for his pre-op visit and the lady tells him the insurance company called and they are not gonna pay. They said they made a mistake in approving us to start with we did not send enough info. But, our approval letters say based on the info submitted you have been approved. Now they have cancelled our dates. Do you think we have a case are can they get by with this. Any info or suggestions would be great. I'm so sad and mad at the same time. Its not right. Thanks for listening.    — jennie_jen (posted on October 4, 2003)

October 4, 2003
DO NOT GIVE UP!! I'm not familiar with your particular insurance and I know that it is depressing when they do this, but they have to have an appeal process and once they approve a surgery, they cannot just take it away. Now, if they have a limit on how long an authorization is good for, they can say that it ran out. The best thing you can do is to look at your insurance policy and see if it states how long the authorizations are good for. You can fight this, but I'm not sure I would get a lawyer just yet because that could only end up costing you money. Try to resolve it yourself. You would be suprised at what one person can do when fighting an insurance company, just be persistant!
   — tmchase62

October 4, 2003
Hi Jennie: How horribly unfair to you and your husband. I don't know if it's illegal to say they approve the surgery and then recind the approval or not. You can call and ask an attorney that specializes in insurance issues. Usually they will consult with you over the phone for free. You might not want to hire an attorney yet, but I sure would get their opinion on if you had a case or not. Good luck, and I hope you get your approval.
   — sherry hedgecock

October 4, 2003
Seems like you've over looked the most obvious question. Ask them why? It may be something that you can fax to them and move on. Don't let the emotions rise until you have all the facts.
   — rleffler

October 4, 2003
I think this is really unfair to you but insurance companies can and do this to people every day and it is perfectly legal. I wouldn't give up without a fight tho. As a previous poster said, call them up and ask them why. Maybe they only need something else from you. Good luck
   — Delores S.

October 4, 2003
If you can't get the paperwork straightened out and you want to know if it is legal for them to recind an approval, call the insurance commissioner's office in your state.
   — bethybb

October 6, 2003
They said they need the diet history and I do not have it. I haven't been to my pcp in over 5 years. I contacted my insurance commissioner and yes they have the right to recind so now what? They approved us based on what we sent in. I guess this is over a year of my life wasted. thanks everyone for your help.
   — jennie_jen

November 23, 2005
Jennie W., I just read your post and I know that it has been a couple of years. In you last post you said "I guess that I just wasted a year of my life." I sure hope that you do not feel that way anymore. I hope that God helped to answer you about the insurance and I hope that you and your husband both got your surgeries. I have been fighting for over two years to get mine and I am now about to change insurance companies and start over. best of luck on your journey to a healthier, new you. Heidi :-)WV
   — Heidi P.