Question:
Has this happened to any of you.

My insurance company wrote back to my surgeon and stated that while I might be considered for the gastric bypass, they did not pre-approve surgeries. They went on to explain the benefits and how to file a claim after the surgery but made it sound like no determination would be made as to whether or not to pay the claim until after the surgery. What the heck do I do now? I feel confident that I have a strong claim, with co-morbidities and two doctors who have wanted me to do this a long time ago, but still..shouldn't an insurance company be willing to commit? I have a private pay policy which I have had for 20 years and they always paid my surgical claims before with no question. Any suggestions or interpretations?    — Sherry M. (posted on October 21, 2000)

October 21, 2000
YES!! My insurance did the exact same thing. I have BC/BS Federal Employees Program. They would not "precertify" my surgery ... but told my doc that if I met the criteria in their policy for WLS then it would be covered ... AND they did precertify my "admission" ... So my doc had them fax him a copy of their criteria ... determined that I met it ... and scheduled me for my surgery ... I am scheduled to undergo a LAP RNY on 11/29/00. Try having your doc request a copy of the your insurance critiera to determine if you meet it ... if you do, maybe your doc will feel comfortable that it will be covered and schedule you. Keep me informed!! Good luck and God Bless!!
   — Donna H.