Question:
Has anyone gotten this?

I received my approval letter today. I was so excited, but, then I read a paragraph stating Please understand that this determination is not a guarantee of coverage or reimbursement, and should not be relied on as such. All reimbursement decisions are made strictly in accordance with written plan provisions blah blah blah. Has anyone ever gotten this and can you tell me what it means? Am I approved or not? The first paragraph says it appears that the RNY is covered under the provisions of this patient's medidcal plan. HELP -- HELP -- HELP    — Jen L. (posted on December 14, 1999)

December 14, 1999
WELL I'M NOT SURE IF THIS WILL HELP..... BUT HERE GOES MY INSURANCE CO. APPROVES WLS UNDER CERTAIN CONDITIONS LET ME TRY TO EXPLAIN WLS IS A COVERED BENIFET FOR MOST INSURANCE CO BUT YOU HAVE TO QUALIFY FOR THE PROCEEDURE FOR YOU TO BE COVERED THIS SOUNDS CRAZY BUT YOU GO THOUGH DIFFERENT STAGES OF APPROVAL ONE STAGE SAY'S YES THIS IS A COVERED BENIFET THEN SAYS NOW PROVE TO ME YOU QUALIFY FOR IT WHICH YOUR DOCTOR CAN DO FOR YOU I WOULDNT WORRY TO MUCH BUT I WOULD CONTACT THE INSURANCE COMPANY AND TALK TO THEM THEY ARE THE ONES WHO CAN EXPLAIN IT BETTER TO YOU..... SORRY IF I CONFUSED YOU IN ANY WAY.........HOPE THIS HELPS
   — Ann F.

December 14, 1999
Hi, my 'approval' letter stated the same thing. (BC/BS) I am now 7 weeks post op as of today. I haven't received any bills saying I owe anything. Just statements of what was sent to the insurance company. Sounds like you are on your way! Congratulations!
   — Sarah D.

December 15, 1999
I got the same letter from BS/BC. I called them and was assured that I was covered. Then after surgery I got a statement of benefits denying payment because the surgery was obesity related. I was told, when I cslled BS/BC that the forms would have to be resubmitted using different 'codes'. If BS/BC doesn't pay I will owe my surgeon over $5,000 and the Anesthes. over $2000. I've contacted the surgeons office and they have agreed to resubmit. I keep calling the other doctors office and nobody ever answers the phone. I'm still waiting for more statements to see what has been decided. BC/BS paid all but $10 of the hospital bill. The $10 was for a private room that they insist I didn't need even though the Doctor requested it, not me. Hope this helps.
   — kaydeeb16

December 15, 1999
My understanding is that no insurance company will GUARANTEE anything. Approval or pre-authorization seems to be standard wording. They won't even GUARANTEE to pay for what they say they will in their brochures! That word is not in insurance vocabularies!
   — vitalady