Question:
Should I self pay and fight for approval later?
It is official, my insurance has denied my surgery. I am eager to have this done and am considering going ahead and doing a self pay while I go through the appeal process for reimbursement. Is this stupid? Will self pay lessen my chances of payment or will it help demonstrate my desparate need?Also, if I have complications will insurance pay for those or will those charges be denied as being part of the surgery? All advice , suggestions , experience welcome, Thank you. — [Anonymous] (posted on July 10, 2001)
July 10, 2001
I am self-pay also and I asked my surgeon this very question and he told me
in his experience the insurance company would be less likely to pay if I
self-paid then fought them. He had one instance where he thought a patient
had a decent shot at an appeal but the patient didn't want to put the
surgery off and self paid and the insurance company completely disregarded
the case. I think if you have a good shot at getting approved to exhaust
that option first then self-pay only if you have to. Self pay's also have
the added worry that if there is a complication, the surgery could end up
costing them twice as much as what they thought. Some insurance companies
will not pay for the actual surgery but if there are complications, they
will pay for the added cost. That is what mine finally agreed to. Good
luck!!
— Elizabeth C.
July 10, 2001
I told the doctor I would self pay since my policy has an exclusion for
weight loss surgery. I was sure getting CIGNA to pay was a lost cause.
Sure enough, CIGNA denied my request. Still, my doctor's office filled an
appeal, and today CIGNA agreed that weight was the cause of most of my
health difficulties. Will they approve me? I don't know, but since I have
a late surgery date (8-28-01) I have a little time to let the system work.
At least now, I have a little hope CIGNA will come through.
— blank first name B.
July 10, 2001
Are you absolutely sure the fight is over with your insurance company? What
was the basis for denial? An exclusion is not a valid reason if you are
morbidly obese. I can send you the letter I used to be approved without
having to file an appeal. The insurance companies want you to give up and
believe it's a lost cause. If you qualify for the surgery, it's not a lost
cause.
— Lisa B.
July 17, 2001
hi..
please please dont give up. sometimes thats what they are wanting/hoping
for.. Im sorry I dont know whats its like...but i do know that its easier
to pay, but lol get mid-evil on there ass...good luck.. i hope it works out
for yea...
— sherry F.
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