Insurance Problems

After telling me and my surgeon's office that I am covered for weight loss surgery six months ago, my insurance company is now telling the surgeon's office that I'm not covered. My surgery is in 16 days!!!! Any help out there?

Have you checked with your insurance yourself to see why they are saying you are not covered?? And are they saying that you are no longer on the plan or that weight loss surgery is not covered?



A lot of times customer service reps give the wrong answer when it comes to benefits. It is always in your best interest to read your plan documents yourself and know them. If weight loss surgery is an exclusion under your plan then there isn't much you can do. You can always appeal - but it won't be an easy battle of its clearly excluded. I'm sorry that you're going through this now. I would be calling the insurance company ASAP to find out why you are not covered.

I have worked in the medical insurance field for nearly five years and it sucks when the wrong info is given over the phone. It happens more than you think. And that's why the insurance company puts that little disclaimer message at the beginning of the call because they dont want to be held responsible.

Thank you for your message. It made me feel better to receive it.

The insurance company told my surgeon's office yesterday that I had a bariatric exclusion. However, they had told the surgeon's office in two other phone calls, one of which the surgeon's office documented, that I was covered, and they told me that I was covered as well six months ago when I called them.

I called the insurance company this morning and spoke with a supervisor. She said she would look at my contract to see what it says.  She said it is possible that the wrong information had been given to me or that it was new information that hadn't been updated on the system. She said she would check into the reference number I had given her from the surgeon's office (where they said the insurance company told them I was covered) and find out exactly what was said during that phone call.  She said it would take her a few days to get back to me.

 

Would you appeal now or wait a few days for her to get back to me?

 

 

I do know that the approvals are only good for six months.  Did you loose more weight in those six months and maybe your BMI is too low now?

Thanks for your message. No, my BMI isn't too low.

I called the insurance co. supervisor to find out why they denied me coverage and she said she will look at my contract and that it's possible that the wrong info had been given to me. She is looking into it and said it will take her a few days to do so.

I agree with Misty.  It could be a misinformed Customer Service Rep.  But to find that out you must first find out WHY they say you are no longer covered.  From there, you can figure out how to fix it.  But without the cause of the problem there's not much you can do.  Call your Insurance Personally.  Ask for copies of the preauth they previously authorized (and any other relevent documents).  Good Luck!