I am going to...
I am 6 days away from my surgery and my advocate from the hospital called me this morning with the news that my insurance changed its policy and have denied me AFTER they approved me months ago!!! She told them that without this, I am going to need a liver transplant eventually and I am not a good canidate and they said they would pay for a transplant because its necessary, and this is cosmetic!! I am going to lose it!! We already have gone broke with expenses for this surgery only to make it this far and thats it. Done. What now?? I can do self pay but they need $40,000 up front!! How can I do that??? I cant! I am so upset!! I have been on a liquid diet for 3 weeks, physically sick and now this! I am just devestated!
What kind of insurance changes its policies mid year?!? I think you should contact the insurance company because I have NEVER heard of that. They frequently change coverage at the beginning of the next year, but if you are already approved, the new coverages would not apply. Also, if you have a copy of the original approval, you can hold them to that.
Take a deep breath, calm down a bit, and call the insurance company to see what is going on.
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
We have preferred one insurance and they changed it a month ago to exclude bariatric surgery due to the company size of less than 250 people. We called the insurance company and were told nothing we could do. Advocate called and said to talk to HR at the company...that is where we are at now. HUsband is on that since he is the policy holder. So now i am waiting for a call. The change apparently happened over the 3 months we did not have insurance due to my husband contracting with another firm. same insurance company and everything, but my former approval doesnt count because we were off the policy for 3 months, which means we started over. We even started over with deducts, so we have gone broke with all this.
So if I understand correctly you had an insurance policy that covered bariatric surgery and that agreed to pay for your surgery. Then you lost that insurance policy and for three months had no insurance. Now you have a different insurance policy with the same insurance company, only this policy does not cover bariatric surgery? Is that correct?
If I am understanding correctly, I don't think there is any way to appeal. When they approved you before, they were saying your old insurance policy would pay for your surgery. But when you lost that insurance policy, and were not longer paying the insurance premiums for that policy, they were no longer obligated to pay for your surgery.
They didn't change the rules on you. You got rid of your insurance policy and then got a new policy that doesn't cover WLS.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
When we got our insurance back, everything was the same. We have been told by my surgery center that everything was still approved, until today. this is the first I have heard of that. In my seminar last week, we were told we were approved and that our share would be XXX amount. Now this?? I am so confused!! Our previous insurance witht his company didnt cover bariatrics except in the case of life-threatening situations, we had to jump through hoops to get that approved then. Im at a dead end. Nothing I can do. Unless they decide to implement an exception to policy, its over.
Unfortunately, Kelly is probably right. Since you actually dropped the original policy and then came in under a new policy that has new coverage, there is probably very little that you can do, especially since the original approval was even on an exception basis. It sounds like the doctor's office made an assumption about your coverage when they told you that it was still approved. The approval was under the old policy which you no longer have. Perhaps they will make an exception, but that is not likely given the cost of the surgery and lifelong follow up care.
Although for several years a number of companies were ADDING some type of WLS to their coverage, the pendulum seems to be swinging in the other direction now and companies are now DROPPING the WLS coverage because the cost of healthcare has skyrocketed and they are seeing how high the additional costs can be for WLS patients well beyond the original surgery cost. What we DON'T spend on care for diabetes and other health problems, we do spend on complications, additional lab work, etc.
I am sorry that you find yourself in this situation, and I do hope they will at least consider an exception.
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
