Major problems and I haven't even had a consult. Any ideas?

I have a couple of questions for y'all.  First let me explain what's been happening.  I got a referral from my physician for a surgeon, I called and talked to the patient navigator and she told me she would have to call insurance first and see what I would have to do to get qualified.  Meanwhile, I sent my medical records to their office.  Almost 2 weeks later, she called me back saying insurance wasn't going to approve this surgery because we are in a preexisting waiting period.  This basically means that, because we had to wait 3 months for our insurance to kick in, we technically "didn't have insurance".  The insurance company says that if you "don't have insurance" for 90 days, they put you in this waiting period which says they won't pay for surgery until that waiting period is up.  This waiting period is a year. I then talked to the financial side of the surgical center and talked to them about being a cash patient and they said the surgery is 15k, which is doable.  Then she said, the money has to be paid upfront 10 days before surgery.  No payment plan can be done; this, isn't doable.  I don't want to waste another year of my life feeling like this.  MISERABLE.  I want my life back and I feel so lost. 

So my question seems to be floating toward, what are the options of getting a 15k loan?  I don't have great credit because another insurance company completely screwed me over when I turned 18 and had to have my gallbladder taken out.  Turns out, that I didn't find out until after that surgery that insurance wasn't going to cover it because they considered it preexisting.  ANYWAY, does anyone have any ideas as far as finding a loan? Has anyone done something I haven't even thought of? 

Thank you in advance and sorry it's so long,

Sarah

I believe what this insurance company is trying to do is against the law. "Pre existing " conditions and I believe not having insurance for 90 days and them imposing a one year waiting period,falls under the same pre existing issue. 

The Affordable Care Act,ACA, has made these types of delaying tactics against the law. 

I believe I would write my insurance company a letter ,sen it certified mail, and tell them just that. I. Would tell them I expected to be approved immediately and to have all My other health needs met immediately. If they didn't,then they would be hearing from my attorney. This last might. Be a bluff,but. They won't take the chance thT you really do have an attorney.

gl

I am not an expert of insurance but this sound completely unreal!  And NO insurance company in the US can refuse treatment based on "pre-existing condition" anymore.  Do you have this insurance through your job, hubby's job, etc?  Can you change the insurance company to one that is more realistic?  And I have to say, when I had my lap band surgery in 2007, that hospital waited until I was at the check in desk right before surgery was scheduled and asked me how I was going to pay the $2000.00 downpayment, cash, check or credit card!

My insurance at that time didn't allow for this and I went into surgery without paying A DIME.

This has nothing to do with insurance but I think it is probably going to take many months before you would be ready to have surgery. The surgeon's office has lots of things that you have to do before they will operate. At least that's the way it is with my doctor. I went to the first introductory session is August and my surgery is this Thursday May 8. You might want to check with the doctor's office. It could be that by the time you are ready to have the surgery, the money situation and insurance would be different. 

I've had insurance lapse, and then contacted the insurance company, paid the premium and got the insurance reinstated.  If you can get it reinstated to bring you up to the time of your new coverage, that would eliminate the waiting period.  Then you could cancel the insurance you got reinstated.  Don't know if it's doable in your case, but might be something you can look into.

Good luck to you.

Hi Sarah.

1) I think possibly your insuance company can do whatever they want (not ALL companies must comply with the Affordable Care Act as of right now.  there are extensions for many employers, some up to as late as 2016.  you can ask your company if they are under the ACA or not.).  So you may actually have to deal with the one year waiting period.  Of course, you can always appeal any policy or decision and that  may be worth a try.

2) As far as credit goes.  There most definitely are medical credit companies and some of them have made it easier to get approved than it is to get approval from the average commercial credit/finance company.  Look long and hard at the interest and fees.  Not saying it wouldn't be worth whatever it costs, but you should always keep your eyes wide open whenever you sign a credit agreement.  Unscrupulous lenders make a fortune on people's desperation and need.

3) The only medical credit company I know of is called Care Credit.  But you could probably find many more if you do an internet search.  Your doctor(s) and or dentist may also be aware of some of what is available in your area.

Whatever happens, good luck to you. Don't give up and try not to be discouraged.  These type of roadblocks usually work out the best for everyone in the end.

I hope it works out for you with coverage. If it doesn't though, don't give up!! I highly suggest starting your weight loss journey now regardless. I lost 55 pounds before surgery and it helped me so much--especially getting used to the habits I would need. I followed protein of 80-100g, lowish carbs (50-80), and around 1200-1500 calories. I tracked everything on myfitnesspal and I started my exercise program. Even if you have to wait, having and conquering small goals in the meantime will make time go faster. 

I know the process is frustrating. Good luck!