Question:
Denial After Approval

In 12/02 I sent my insurance comapany everything you can imagine to get approved for surgery. In two weeks they sent me a letter of approval provided that my psych consult was okay (I had not had it yet at the time they approved me). The surgical group I was dealing with was messing me around really bad. They had my psych consult but were very rude to me. Here it is in March. I had no date yet. My insurance is POS which means I can go out of network. So I decided to go out of network since the surgical group was messing me around. My psych eval is fine. Do you think the insurance company will deny me now or can they deny me now after they approved me already, just because I want to go out of network now? Please help!!!!!!!!!!!!!    — Marcy G. (posted on March 16, 2003)

March 16, 2003
I was approved and had surgery date and then changed surgeons. With the new surgeon I took all of my test results, cardio, pulmonary, psych and sleep test to new surgeon and the submitted to insurance again. I had no problem getting approved for the new surgeon. Good luck.
   — Stacey F.

March 16, 2003
It might have to go through another medical review since your doctor has switched. BUT! if was deemed medically necessity the first time, it's unlikely they would change their mind. (You have the letter that states that, which would make a great case). I did the same thing with PS. I switched to an out of network provide. He had to send in his own medical necessity letter and info. Call your insurance and tell them your plan and ask them what is the proper way of doing that. GOOD LUCK! I don't think you'll have a problem (my opinion)
   — ZZ S.

March 16, 2003
You approval was because you qualified medically for WLS, not because you chose an in-network provider. They don't care if you go out-of-network as they are still going to pay the same. If it's more it's your problem. That's the blessing of a POS, pick up and go where you want without anyone's referral or blessing. <p>Most likely all they will want is a letter from the new surgeon indicating what he will do etc., to make sure it is a covered benefit. If it's just like you were going to have done then it should not be a big deal.
   — zoedogcbr