Question:
My insurance company said the approved the surgery then after said they didn't say

that they would pay. I had complications while in the hospital and had to have my spleen removed and was in the hospital for 9 days then and later on that same month I was in for another 8 days. I have the approval letter for the surgery now they won't pay since they didn't say they would pay. Has anyone had this problem and what did you do? My hospital and Dr. bills come to over $150,000.00. My Dr. keeps sending in more letters to them but so far they are only paying some other related bills to the surgery. Help me put together a letter for the State Ins Commission and to them. I had surgery on May 28, 2003.    — Toni W. (posted on August 26, 2003)

August 26, 2003
Toni, I had the same problem as you did about insurance and I do mean the same problem, but after me constantly calling the insurance company and proving to them that they did tell me they would pay for the sugery they changed their mind. They told me that they had made a mistake and was sorry for the inconvience they had caused me (they said insurance companies do make mistakes also). Just keep hounding them and I am sure they will change their mind. I am sure they don't want any bad publicity. Gene Fisher
   — Gene F.

August 26, 2003
What exactly does the approval letter read? Mine ready that RNY was a covered benefit under my policy. It then went on to say some junk about that payment would be based on the policy at the time of treatment etc. Since my policy is good for a year all I needed in writing was that it was a covered benefit. I know that I could end up with some bills as none of the providers involved had a contract with BC/BS but I knew that the great majority would be covered. When it was all said and done they paid everything but $101 of my anesthesiology bill. Not bad for $26,000 in charges. <p>You need to ask them what in the heck they approved then. Why did they even send a letter etc. The whole thing is ridiculous. Any layman would interpret an approval letter to mean they will pay up to the limits of the policy, which would have to be a lot more than they have paid so far.
   — zoedogcbr

August 27, 2003
First of all there is a disclaimer on the bottom of the approval letter that says it is not a guarntement of payment, HOWEVER, if your were eligible at the time of the surgery, and your insurance approved the surgery to be done, you used a network facility with the surgeon that the insurance covers, they do owe the bill. I would talk to a lawyer.
   — LS F.