DENIED!!!

Has anyone else had this happen?  Before I started my lapband journey, the doctors office called my insurance to make sure this was covered.  They said that it was and gave all info needed to get approved, including my co-pay amount.  Now that I'am finished with all requirements needed for the surgery, insurance has denied me saying this is not covered and that they told the doctors office that it was not.  I don't know what to do.  I'm upset and mad all at the same time.  I have come so far and I don't want to turn back now but there is no way I am able to pay for the procedure myself.  Someone help!!!!!     

Hey Kris, I don't have any advice, but wanted to send you a hug. I think if I did have any advice, it would be to read over your policy and find out if it is indeed a situations as this surgery not covered. Another thing you might want to do is contact your employer (human resources--I believe) and find out what it is you can do to fight this. I believe some folks have gotten an attorney to fight their cases or even an advocate to plead their case. I have a friend that had the same issues as you and he had an advocate go before a committee to get approved. I know it's difficult, but hang tough. If it does turn out not covered, perhaps you can change insurances? My DH and I had to do that before we got approved. We were fortunate, because his employment was in open enrollment. Our timing couldn't have been better. Good luck to you-- Dee

Thanks for the hug!  Also could you please say a little prayer for me.  I plan to appeal as soon as the doctors office gets everything ready.  I spoke with my lawyer today and he told me to fight, so here I go.

I am so sorry for you but I would fight.  Hopefully your doctors office got the name of the person who gave the information.  I too would go to your HR at work and request to see your policy.  I also know of a person who switched jobs and I know of someone who waitied for open enrollment and they could choose a more expensive policy that did cover it.  But if your company has there on exclusion to WLS you are up a creek.  Maybe even your surgeron insurance department could call with the name and information they were given and talk to a supervisor.  Just dont give up yet. Jane

The doctor's office did get the name of the person that said it would be covered.  They now say that he misquoted and the procedure is not covered.  They also stated that this person would be told of the situation and inform them to clarify before giving information again.  I have talked to the person in HR and they are trying to see what they can do even though they say it is not covered, we are hoping because of the pre-approval in the beginning, they will honor that.  I'm going to keep my fingers crossed and legs.  haha 

I was in a simular situation and I did have to look at my policy, change procedures, and hire an attorney. What insurance do you have? I found my policy online at my insurance website, printed it out, and handed it to my doctor. the attorney and called my customer service rep daily to get them to clairify for me exactly what was covered and what was not. When is your does your new "year" begin? Please hang in there and don't give up the fight. The fight is really worth it and there just may be a loophole. If you need anything or if you have any questions I would be glad to help. Katherine

I have BCBS.  I have heard a lot of people saying how much trouble they have had with BC.  When I spoke with BC today, they told me if I had already had the surgery done, they would have to honor what the doctor's office was told and cover it.  I feel like they should honor it anyway because I would have never started this journey knowing that I would not be approved.  They gave me false hope!

I am so sorry to hear about this.  I would keep fighting it.  What type of BCBS?

I have BCBS also.  The same thing happened to me.  I called them prior to any tests or consultations to verify it would be covered and was told yes.  Then my doc's office also called to verify benefits prior to scheduling me for anything.  They were also told I had benefits.  When they sent may packet up for final approval with all my test results and everything they needed, BCBS denied me saying it was not a covered benefit.  My doctors office appealed, stating who we spoke with and the date and time, and within 2 weeks they approved it.  Just hang in there.  I know what you are going through.  But hopefully they will appeal and get you approved, if not, hire a lawyer.  I will be praying for you.  Good Luck Beth

Thanks for the good news Beth! You went thru the exact same thing. The doctors office has started my appeal process and i hope the letter will be going out tomorrow, if it hasn't already gone. I have talked to about 5 different people from BCBS but so far I'm not getting anywhere so hopefully the appeal will work!!! you have given me hope! Thank you so much!

You take care and God bless you!