Question:
Do you think I need to get a lawyer and do I have a chance to win our approvals?

Okay, my husband and I were both approved for Gastric bypass back in July by Employee Benefit services with just the surgeons letter. When my husband goes for his pre-op visit in October they call and say there not gonna pay that they made a mistake and we shouldn't have been approved. I have both approval letters. They say we do not have 6 month weekly attendence weigh in, 3 of the last 5 yrs. supervised diet. Ok we don't have that. I sent in all the pre-op test we had done, we also have co-morbidities. I sent in over 40 pgs of info for us and they say that they are still not gonna pay. We spent out over a 1000 dollars for pre-op testing based on the approval. I have been told that I have a case and can win it. They are not returning calls and being very rude. What do you guys think?    — jennie_jen (posted on October 21, 2003)

October 21, 2003
Did your insurance provider change their requirments after they approved you? Many insurance companies change their requirments for approvalal most on a monthly basis. I would think that if you met their requirements at the time they approved you, you should be o.k. However, if it was truly a mistake by somebody in their office, I don't know what your options would be. I would see if you can get a copy of their requirements and any changes that have been made in the last year and the dates of those changes. Good Luck.
   — Carolyn M.

October 22, 2003
Contact your states department of insurance and explain the situation and give them your approval letters. They will contact EBS for you. Believe it or not insurance companies are terrified of the DOI.
   — RebeccaP