Question:
Can they really do this?

i'm so friggin mad right now, after all i went thru for these stupid people and now they want more. i had my case before a review board from the people who administer the plan and they approved wls as medically nec. well now they said i have to go to blue cross and have them pre-auth. my surgery. how can this be? when i first started this, they told me they don't give pre-auths and now they said i need one. can they keep changing things like that on me. i got the approval from my husbands union. here's what it says:the funds medical consultants have reviewed the documentation for the proposed gastric bypass surgey for your wife. they have recommended that benefits be allowed for the surgery as it is deemed medically nec. the fund will therefore pay its allowable benefits,ater benefits have been determined by mrs. carrillo insurance. Please be advised that this is not a pre-auth. nor a guarantee to pay any claim;it is and estimate of coverage based upon the information provided.Prior to any claim payment by the fund, each claim is reviewed for plan benefits, provisions, exclusions, limitations, and reductions in effect on the applicable service date,and the member must be eligible for benefits at the time the services are rendered. NOTE; PRIMARY DENIED ME BECAUSE OF AN EXCLUSION. o.k. one more thing wls if medically nec. is a plan benefit. did anyone have to get pre-auth and how long did it take. all pre-op testing done, surgery schedule for 4-30-01 that's only 6 business days away.. help!!! any input would help out    — enriqueta C. (posted on April 21, 2001)

April 20, 2001
Please read my about my similar experience. I can send you an example of what I sent my insurance company to get my denial turned around in two days if you'd like. Just let me know.
   — Lisa B.