Question:
Has anyone had to get verification that ins. plan covers RNY surgery, in writing?
This is what OSU bariatric program wrote me: "We need verification that your insurance plan covers gastric bypass surgery, in writing. You should be able to obtain this from the employer's human resources department or from the customer service department of Medical Mutual. This is a requirement of the Department of Surgery; they will not make an appointment until the written verification is received." I'm already approved by Medical Mutual of Ohio and Aetna, yet they are requesting this! I've tried calling Med Mutual 4 times, and tried emailing them twice and they keep saying the same thing..."There is no other letter that can be generated. The provider needs to contact Medical Mutual to verify benefits." But OSU will NOT accept this! OSU will NOT call them, it HAS to be in writing. I've waited over 7 months since I've applied to OSU and I'm really getting upset over this...is there any suggestions out there? This doesn't seem fair! You can't produce something that isn't there, there isn't an insurance handbook for the company I work for. HELP!!! — Connie B. (posted on March 16, 2003)
March 16, 2003
Hi Connie. I have two suggestions for you. 1.) Ask OSU Bariatric Program
for the Procedure and Diagnosis code they use for billing for RNY. Then
call call your insurance company and ask them the benefit under your
employers policy. 2.) When you have this information, advice the customer
service respresentative you need a general policy letter of that benefit
for your doctor. If she says no, then ask to speak with a supervisor. I use
to work for Blue Cross Blue Shield of Michigan and people called for this
type of thing a lot. I hope that helps!
— Steph P.
March 16, 2003
I agree with Connie, but also another thing you can do is ask the benefits
specialist with your company for a "SPD" summary plan description
for your insurance plan. Insurance companies are required to provide
"SPDs" to all members. If you do not have a benefits specialist
with your company, then call the insurance company and ask them for the
"SPD".
— Debbie B.
March 17, 2003
The previous poster hit it right on the head. Insurance providers are
LEGALLY obligated to provide an 'SPD' (Summary Plan Description) to those
whom are within the Plan. I find it hard to believe that any HR department
would not have this readily available. It is part of their responsibility
to know these types of things.
Good luck.
— Diane S.
March 17, 2003
This may be a silly question, but didn't the insurance companies send
letters to OSU telling them that you were approved?
I thought it was common for the insurance company to send a letter to both
you and the facility where the surgery is to be telling you and them that
they would cover the procedure.
Medical Mutual says there is no "other letter" that can be
generated. What letter did they already generate?
As for the handbook, your company is required to provide you documentation
of your coverage as other posters have mentioned. Obviously though, if
you've been approved, it's a covered benefit.
Good Luck
— Carolyn M.
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