Question:
VSG scheduled for 8/31/10 yet no authorization??????

I was scheduled for surgery for 8/30/10. I had gone into my surgeons office on 8/4 and spoke with the insurance specialist in regards to my claim submission. She informed me that VSG usually is denied but that she will appeal and get it overturned by the surgery date.....ummmmm its 8/27/10 and all I get is on Monday they will definitly know...this is so nerve racking its incredible its been a long journey to this point and yet I can not get excited because I don't even know what is going to happen. Also, its upsetting how I've been really trying with this pre-op diet and lost 8lbs and my surgeon says to me AFTER I do pre admissions and sign authorization for surgery, that if I don't go on OPTIFAST (which they sell) he will be canceling my surgery!!!!! Am I just taking this the wrong way because I am emotionally stressed with everything else or is he wrong in saying/doing this??? I lost some weight?? can I get credit for that???    — mperez77 (posted on August 27, 2010)

August 27, 2010
Please be careful with this one. My drs office had pre approval from my insurance and so did the hospital, but the Blue Cross Blue Shield is now denying it saying it is excluded on my policy. There is a disclaimer on their preapproval letter saying it does not guarantee payment. I have exhausted my appeals with BCBS and now have to go through an external appeal with the insurance commission. I can also file a civil suit which I will do if necessary. I would not have had the surgery if I didn't think it was going to be paid for by my insurance. I would postpone my surgery if I were you and make sure you have a definite approval before going ahead. Good luck
   — Nancy W.

August 28, 2010
So sorry for the stress you're going through. I was a basket case by the time I finally had my surgery, but it ultimately was worth it. So hang in there. I even had to delay my surgery more by changing doctors because I did not get good vibes about the first one. Did your doc explain WHY he insists you go on OPTIFAST? I haven't heard of a doctor insisting on the brand they sell if the patient chooses to use something less expensive that has the equivalent nutrient content. You're in my prayers. God bless.
   — Janell C.

August 29, 2010
Boy, everyone is out to make money off of you. You should wait until you get authorization from BCBS before going ahead with the surgery. As far as the doctor insisting you buy Optifast from him, I think that borders on an unethical practice. I'd tell him, thanks but no thanks, and lose the weight as you have been doing. Just remember, insurance companies are out to make money too.
   — Muggs

August 30, 2010
well, it's August 30th and I just received a call from doctor's office. Now they are telling me I have to wait for a BCBS decision by tomorrow at 9am....they re-scheduled me for 8/31/10 at 7:45!!!!! What did they say can we re-schedule for thursday.....I am so emotional right now its insane.....how could they wait for last minute to get approval. Why would they make me anticipate a date for WLS when in reality it should have never been set in concrete.... I don't know who to believe anymore or what to believe.....This is something I do not wish upon anyone!!!!!
   — mperez77

August 30, 2010
I apologize, in regards to the OPTIFAST, I had explained that I was a single mother of three and that paying 150.00 weekly for the OPTIFAST plan was not feasible for me and if I can go on a liquid diet on my own. This was not something they were willing to accomodate. They said I HAD to go on the optifast plan and if not they would not continue with the surgery. OH they did lower the price to 100.00 weekly for three weeks.
   — mperez77