I feel so low y'all....

thestarsarespellbound
on 12/5/19 10:38 am

My Surgery is set for Monday Dec. 9, 2019. Monday I got a phone call from my insurance's approval team saying that they were denying my surgery coverage due to a provision in my employers insurance policy. The coordinator at my doctors office had spoken to the insurance customer care team back in May when I started this entire process and they told her I was covered. When she called again on Monday they told her I was again covered but the approval team said I'm not. Both I and the Benefits coordinator called several times They said my only options was an expedited grievance, which I wrote out and submitted on Tuesday, I was told the the decision would be made by today and guess what? I was denied.

I feel so discouraged. I don't have Monday to pay for it, I spent so much time and effort, was on the liquid diet. Since before thanksgiving.

I feel lost and upset.

TheWombat
on 12/5/19 10:43 am
VSG on 06/11/18

Have you spoken to the insurance coordinator in your surgeon's office? They may be able to help.

thestarsarespellbound
on 12/5/19 11:01 am

Yes, she was wonderful and fought very hard for me as well.

TheWombat
on 12/5/19 10:45 am
VSG on 06/11/18

Also, this link has lots of ideas on how to reduce the cost of surgery:

https://www.bariatric-surgery-source.com/cost-bariatric-surgery.html

thestarsarespellbound
on 12/5/19 11:01 am

Thank you! I'll check it out now!

Amy R.
on 12/5/19 2:15 pm

I'm always so sorry to see this type of post. When an insurance company agrees to any procedure here at our house, we get them to send us that answer on their company letterhead. It's saved us a few times over. We had to learn it the hard way.

But most people don't think of that and especially if they've never been in a situation such as yours. You might want to start doing that from here on out, although I know it won't help you right now.

When you actually read your policy through for yourself, what does it say? If it doesn't flat out decline to cover bariatric surgery you may have an opening. Especially if they approve on a case by case basis. You've got lots of documentation (I'm hoping) that would support an appeal.

If that avenue is completely closed there are still other options. Some places finance medical procedures. There is one called Care Credit and perhaps that could be an opportunity? Other folks dip into their retirement/401k because they decide that this surgery IS really that important. There is also Mexico, etc. and if you haven't had a chance already you may want to look into that.

Knowing there is no magic answer makes it difficult to encourage, but you may find something while you're looking through your last options. Good luck to you. Keep trying until there aren't any options left. At least you'll know you've done every last thing that you could.

thestarsarespellbound
on 12/6/19 11:59 am

Thank you so much for your reply. Getting letters from the insurance is a great idea. I will for sure being doing that in the future. I have CareCredit but my surgeon doesn't accept it. I'm looking into a couple other avenues at the moment. I will definitely check out dipping into my 401k or perhaps even taking out some sort of loan. I am not giving up for sure. I worked so hard and if I have to work harder then I have to. Thank you again!

White Dove
on 12/5/19 4:21 pm

Many employers are no longer covering weight loss surgery or have a once in a lifetime limit. Insurance companies are tough to work with. I get approval letters that will say the procedure is covered but there is go guarantee of payment.

I guess that means that they agree I need the procedure but they might not pay for it. It is really strange.

Good luck on finding a way to get the surgery. There is a law firm that specializes in cases like this. Give them a call.

Lindstom Obesity Advocacy

Real life begins where your comfort zone ends

thestarsarespellbound
on 12/6/19 12:01 pm

It is very strange! It's funny but I actually work for attorneys! I am definitely looking into some sort of resolution. Thank you for your reply!

hollykim
on 12/6/19 5:38 am - Nashville, TN
Revision on 03/18/15 with
On December 5, 2019 at 6:38 PM Pacific Time, thestarsarespellbound wrote:

My Surgery is set for Monday Dec. 9, 2019. Monday I got a phone call from my insurance's approval team saying that they were denying my surgery coverage due to a provision in my employers insurance policy. The coordinator at my doctors office had spoken to the insurance customer care team back in May when I started this entire process and they told her I was covered. When she called again on Monday they told her I was again covered but the approval team said I'm not. Both I and the Benefits coordinator called several times They said my only options was an expedited grievance, which I wrote out and submitted on Tuesday, I was told the the decision would be made by today and guess what? I was denied.

I feel so discouraged. I don't have Monday to pay for it, I spent so much time and effort, was on the liquid diet. Since before thanksgiving.

I feel lost and upset.

ca lol

Lindstrom,it is a free consultation call and they may be able to help you.

 


          

 

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