Approved for wrong procedure
whattttt. When I first started looking into wls, I was going for lap band, but have since changed my mind and let my surgeons office know of the change right away. So if this lady knew I switched it, why in the world would she submit a claim for the band?! I am so irritated right now, I can't even be happy of the approval
. The insurance rep that I talked to said the code for lap band and the sleeve might be the same but she wasn't sure....hello you work there how come you're not sure?. I called the insurance coordinator at the surgeon's office, and of course she was unavailable. Guess I have to wait until tomorrow to see what's going on. Has anyone else had this problem? And should I be worried? Because I am
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Thank you all in advance for your Responses, Support, Motivation and Inspiration.
I'm Still a work in progress, I wont give up the quest to reclaim my life, I will be whole again someday!
HW297 SW269 CW 213
. Thanks again!! 
Take a deep breath. I know this has to make you mad as fire ! (I'm from the south can you tell?) I went through all kinds of mess with my doctors office before I got approved and scheduled. It will happen. I just kept telling myself. This is a road block God has placed for some reason. I'm gonna go through this road block with his help, not around it ! Unfortunately God's timing is not ours sweets =( it will happen for you. I'm sorry you are so angry. I understand ! I do ! I have had a many an angry phone call with office manager at my Surgeons office. Some people just don't consider that their mistakes really impact our lives. We are already under so much stress trying to accept we are going to have to have MAJOR surgery. This just adds to it. Sometimes I thought, well this is just a test, they are trying to see if I snap or just go away. lol I DIDN"t !
Good luck to you !
{{{{{ Hugs }}}}}}}
Thank you all in advance for your Responses, Support, Motivation and Inspiration.
43775
I think that other is for gastroplasty ....either way...CONFIRM w/ yer surgeon's office!/CALL YER insurance company...to look it up for you....43775
OK..I just looked up that other...its for OPEN sleeve gastrectomy not LAP!
let me know if ya need the link hth!
CPT
00797 Anesthesia for intraperitoneal procedures in upper abdomen, including laparoscopy; gastric restrictive procedure for morbid obesity
43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)
43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption
43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (e.g., gastric band and subcutaneous port components)
43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only
43772 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only
43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only
43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components
43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e., sleeve gastrectomy)
43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty
43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty
43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)
43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy
43847 Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption
43848 Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure)
43886 Gastric restrictive procedure, open; revision of subcutaneous port component only
43887 Gastric restrictive procedure, open; removal of subcutaneous port component only
I was approved for RNY last year even though I had been going through the process for VSG for six months. At the beginning of the year I got new insurance and had to go through the approval process again, the insurance people again had me approved for RNY even though short of renting a billboard next to the hospital I made it well known I wanted VSG.
A few weeks later the nurse called me and told me surgery was approved and gave me my date for you guessed it, RNY. I told them again I want VSG. I was told they would go back to the insurance company to get approval for VSG and heard back from them in 3 days and was told everything was a go. I had the surgery 3/21 and insurance paid for everything but the surgeon fees and my in hopsital doctor fees as the surgery was "experimental."
So as of now I have 8000.00 that the Cleveland Clinic is trying to collect from me. Over 6 months I have called the insurance coordinator there multiple times to discuss this but have never been given a call back from her. It's very frustrating.
I am really pissed off about it and my next step will be a lawyer. So as I said, make sure you get it in writing.
Pre Op: 415 SW: 390 Goal: 235 CW: 225
