Question:
What can I do about my insurance?
I was pre-approved with my husband's BCBS insurance in 11/03. My husband's insurance expanded their coverage with this company on May 1, without notification, and expanded his policy and excluded benefits for gastric by-pass. My benefits read as follows: Benefits are not provided for gastric by-pass surgery. I also spoke with HR at his job and they said that BCBS made a mistake with the inital approval and that their insurance has never covered WLS. I AM SCHEDULED FOR SURGERY ON JUNE 3, 2004. Please help!!! — Mandy L. (posted on May 10, 2004)
May 10, 2004
My original thought was that if you have the letter in your hand, they have
to honor it. However, approvals are normally good for only 6 months at the
most so it looks like your November approval might expire at the end of May
and not be valid for your June surgery. I'd either call BCBS and confirm
how long approvals are good for (get reps name and date), or see if you can
find the details in your policy as to how long pre-approvals are valid
for.
If you have the letter in your hand, I'd see if my surgeon could move me up
to sometime in May (prior to 6 months from date on approval letter) because
I don't see how they could not pay at this point. The HR departments
aren't always correct.
— Carolyn M.
May 10, 2004
i had a tt and inner thigh lift 2 months ago. i was pre-approved. after i
had the surgery i got a letter in the mail saying they weren't going to pay
it and that it was deemed cosmetic. well since i had already had the
surgery i was freaked out! but...because they made a mistake and approved
it in the first place they had to honor it. look on your paperwork there
should be a time limit that the approval is good for. as long as you dont'
have to get an extension and you have your surgery in that time frame they
should have to pay.
— franbvan
May 11, 2004
If you have the authorization in writing, you have a case to have your
surgery covered. And I beleive every insurance policy written has a
statment in there somewhere that says they can make changes to the plan at
any time without notification. Good luck!
— koogy
May 11, 2004
You are answering my question above. The letter reads that the validity is
for 1 year pending eglibilty at that time.
— Mandy L.
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