Question:
Why won't insurance pay for sleeve after sending letter of approval?

My surgeon cancelled my surgery (october 25th) because he has not been paid for the vertical sleeve since June. Horizon sent me a letter back in august, saying I was approved for vertical sleeve. Anybody ever heard of this one? Approving surgery, then not paying surgeon??    — peppervonpalmer (posted on October 2, 2010)

October 2, 2010
It's only prudent on the doctor's behalf to make sure he will be paid, thus the preapproval letter, but once that is received, most surgeons would perform the operation and then submit their bill. Not require payment up front. I would be asking the surgeon why he did that. Then I would be finding myself another surgeon. Your approval letter is good for any surgeon that meets the requirements of your insurance plan You don't have to 'start all over'. But even before that, call your insurance company to see if they have rescinded the approval...and why. You shouldn't have to wonder what's going on, they are required to tell you, and to put it in writing.
   — Arkin10

October 2, 2010
I agree with Pat! I have never heard of a surgeon requiring insurance to pay prior to the surgery. I worked for a weight loss surgery center and this was never done. Your approval letter should be good enough for any surgeon to proceed with your surgery. Find another surgeon that you are comfortable with and have your records, along with your letter, transferred to him/her. I'm sorry that you had this delay, but it may have been for the best. Good luck with your plans and don't give up, this is just a bump in the road.
   — Bonnie H.

October 2, 2010
wow...I agree with everyone else. the surgeon may charge you (more than likely will under the cicumstances) to copy your records but I would run. I don't pay for electricity before I use it, why would I pay a surgeon before the surgery. Find a surgeon that is concerned about your well-being over being paid.
   — caxb2009

October 3, 2010
The surgeon should not require payment prior to services rendered. I have never heard of an insurance company paying in advance, and I worked in the insurance industry for 18 years. There may be a misunderstanding, that he has not been paid by that insurance company for other patients, so he will not work with that insurance company until they pay for those previous ones. This is very common. I would call your doctor and confirm if they are requiring pre-payment, or if the problem is with prior patients. Either way you can call your insurance company and ask for a case manager to be assigned to you. Usually when you are approved you have other medical issues, diabetes, high blood pressure and other issues. You can request that your case manager coordinate care for you and they can work with you for all of your medical issues. You may not need assistance for other issues, however a case manager is very good at handling problems and getting things pushed through. Usually if you call for just 1 thing they will not assign one so do what you can do to get one assigned. It is also good to have one in the event of any complications. At sometime there is a good chance that you may need some nutritional support, and the case managers are wonderful at handling that also. I wish you the best of luck.
   — dowens67

October 3, 2010
This is a new one to me,being pre-approval and then having your doctor,trying to take your joy away.Go,back to your insurance company,make sure,that is where the problem is and fine out why???Ask,them to reconsider your claim,once again and speak with your doctor's office,too.Do not give up,you will come out on top,keep pushing for your health Brenda
   — Regi02

October 3, 2010
My deductible and my out-of -pocket had to be paid before they would do my surgery.
   — Teresa B.