Add as a Friend
Send Message
Member Card
Block Member
on December 16, 2007 3:41 pm
All, I can start to say is GRRRR.
So after 6mons of being told that my insurance plan covered Gastric Bypass Surgery. I was told via Dr. Lauter's secretary that it was an exclusion on our plan. I said "It is not, they have told me from day one it was covered on my plan, and I've called over 38+ times to be told they were waiting on my papers for pre-determination.
So finally after Morgan my husband, and Dr. Lauters office, sent my papers to inusrance. (all 90+ pages of medical documentation) did they not look at anything but the cover letter saying, Pre-determination for Gastric Bypass surgery. They said. "Its not covered, its an exclusion." without even reading the papers. Well after my 3rd appeal, still no surgery. I was scheduled for surgery Tuesday, but unfortunately have to cancel it due to inability to pay, and no coverage.
We' are taking Lumenos the insurance company to court.
We talked to my husband's employer and the insurance broker, and both are backing us up. They feel that Lumenos mislead and falsely informed me leading me to multiple doctor appointments un-nessessary other than for the surgery, and mental anguish of severe depression when I already was depressed, and possible relapses of Wegener's Granulomatosis due to stress.
Here's the story!
On July 24th, I called to find out about diagnostic code 278.1 and procedure code 43846. The customer service rep said, yes we cover that surgery, that all I needed was the required documentation for pre-approval/pre-determination. She informed me of what papers and services were needed to get the determination going and to go in my favor. (hence the 90+pages of my medical co-morbidities and appts )
I called at least 1-4 times a week every week it seemed (total average was 38+ times in July - Nov 2007. I called again late July to again make sure that codes 278.1 and 43846 are covered. When again I was informed that yes it was.
In the 38 times I called, they never told me it was an exclusion.
They always mentioned that my stuff wasn't there yet and as soon as it was it would be sent out to pre-determination.
When they finally got the papers in Nov 2007. It wasn't even glanced at. They said. Oops its not covered.
So we had done.
Psych Consult
Sleep Apnea test
2 Surgical Consults
Depression consult (anti-depressants)
Nutritionist
Blood Tests
and a few other things.
I called 38+ times about the gastric bypass surgery.
Insurance says, they are sorry and they told me wrong, but that they will not pay for it/their mistake.
So off to court we go to continue the fight!!!
Wish us luck.
Unfortunately we won't be having the surgery this year, but we are fighting for it and more anyways.
Marge Shipman
12-16-07
P.S Now They think I have carpel tunnel (might need surgery on that too.)
Be the first to leave a comment.So after 6mons of being told that my insurance plan covered Gastric Bypass Surgery. I was told via Dr. Lauter's secretary that it was an exclusion on our plan. I said "It is not, they have told me from day one it was covered on my plan, and I've called over 38+ times to be told they were waiting on my papers for pre-determination.
So finally after Morgan my husband, and Dr. Lauters office, sent my papers to inusrance. (all 90+ pages of medical documentation) did they not look at anything but the cover letter saying, Pre-determination for Gastric Bypass surgery. They said. "Its not covered, its an exclusion." without even reading the papers. Well after my 3rd appeal, still no surgery. I was scheduled for surgery Tuesday, but unfortunately have to cancel it due to inability to pay, and no coverage.
We' are taking Lumenos the insurance company to court.
We talked to my husband's employer and the insurance broker, and both are backing us up. They feel that Lumenos mislead and falsely informed me leading me to multiple doctor appointments un-nessessary other than for the surgery, and mental anguish of severe depression when I already was depressed, and possible relapses of Wegener's Granulomatosis due to stress.
Here's the story!
On July 24th, I called to find out about diagnostic code 278.1 and procedure code 43846. The customer service rep said, yes we cover that surgery, that all I needed was the required documentation for pre-approval/pre-determination. She informed me of what papers and services were needed to get the determination going and to go in my favor. (hence the 90+pages of my medical co-morbidities and appts )
I called at least 1-4 times a week every week it seemed (total average was 38+ times in July - Nov 2007. I called again late July to again make sure that codes 278.1 and 43846 are covered. When again I was informed that yes it was.
In the 38 times I called, they never told me it was an exclusion.
They always mentioned that my stuff wasn't there yet and as soon as it was it would be sent out to pre-determination.
When they finally got the papers in Nov 2007. It wasn't even glanced at. They said. Oops its not covered.
So we had done.
Psych Consult
Sleep Apnea test
2 Surgical Consults
Depression consult (anti-depressants)
Nutritionist
Blood Tests
and a few other things.
I called 38+ times about the gastric bypass surgery.
Insurance says, they are sorry and they told me wrong, but that they will not pay for it/their mistake.
So off to court we go to continue the fight!!!
Wish us luck.
Unfortunately we won't be having the surgery this year, but we are fighting for it and more anyways.
Marge Shipman
12-16-07
P.S Now They think I have carpel tunnel (might need surgery on that too.)
