Question:
How can my surgery be approved when the consultation was not?

I recently found out I am approved for my surgery. YAHOOO! But then I just got the bill from my first consultation with the surgeon, $348 with a note on the bill saying in fine print "not covered by plan" . I called the insurance company and sure enough, it's not covered. I don't understand how they can approve the surgery without also approving the consultation? It's not like I could have the surgery without meeting with the surgeon first! Can I appeal this?    — Laurel C. (posted on July 16, 2002)

July 15, 2002
My only question is - Did your PCP refer you? If not, I know my insurnace wouldn't cover the appointment either. You might want to check on that. Good luck and congrats on the date!
   — AphY Girl

July 15, 2002
I'm not sure it's worth appealing, Laurel. The same thing happened in my case, but don't panic or let that alarm you. I'm so excited about just HAVING the surgery and QUALIFYING, right now, I'm not too much concerned about anything else!! The mere fact that I am afforded the opportunity for a quality of life I've not had in a VERY long time. I've now gone into some *serious debt* to have this surgery, but it's because I'm on a mission and I'm not letting ANYTHING STOP ME! You have to assume an *attitude*, so-to-speak, and have the DETERMINATION to press on through this seemingly minor obstacle. You can't fault the surgeon, he has the insurance/billing staff that probably checks out your coverage BEFORE you are even scheduled for the initial consult. This may happen IF your PCP didn't refer you or the surgeon you selected was not in your *network* for your insurance. $348 is a drop in the bucket compared to being a *complete self pay* and having to foot the entire bill (total cost of the surgery). You didn't mention the type insurance you have. As the previous poster asked, "Did your PCP refer you?" I realize the insurance company not paying this amount has upset or discouraged you, but look at the MOST IMPORTANT THING, your SURGERY IS APPROVED~~which means, more than likely, it's covered!!Look on the BRIGHT side, and don't sweat the small stuff. Hope this helps.
   — yourdivaness

July 17, 2002
Laurel, I would let it go for now. I was approved for surgery, then 12 days before my date they sent me a letter of denial. Emotionally I am ready to go off the deep end. In the meantime I am getting bills for all of my pre-op testing. They do not want to cover that either. I am not going to pay for anything until I hear about my appeal. I just wish I would have gotten the denial after the surgery was already over. Then I would worry about paying for it. I just wouldn't risk talking to the insurance company for 300 or 400 dollars in case they would deny your surgery. Susan Wagner
   — Susan W.

July 17, 2002
Hi Laurel, The same thing happened to me and it was a coding error; they coded it obesity and left off the other comorbids. Maybe your surgeon's office should resubmit with the other diagnoses first, particularly if you have gallstones...that was the clincher for me. Take care and best wishes...
   — Ann B.

July 18, 2002
Have your doc submit the claim again. Alot of the times the insurance will pay if they are notified that the surgery was approved. You could try calling your insurance and ask them since the surgery will be paid for why not the visit. It's worth a shot.
   — Kevin D.