<FONT FACE="arial"><TEXT="C71585"> Hi Everyone! Anyone who knows me from chat knows that I've been having a bad time with the insurance :( About two months ago, I called the insurance to find out what I needed to do with regards to the preapproval process. The woman asked me what I was having done and I told her. She proceeded to tell me that I didn't need preapproval for that and to just call the 800 number on the back of my card! "Wow.. this was way too easy I thought!". Anyway, my dr's office called the 800 number and gave them all the information they needed. It was approved on the spot and deemed a medical necessity. Now, let me give you a little background info. I have insurance through the union that I belong to.. the IBEW.. and the carrier is Multiplan. Multiplan is who the dr. spoke to and who initially approved my insurance. All was well, so I went for my preop tests which included...all my bloodwork.. and endoscopy.. chest xrays.. a physical.. an electrocardiogram.. and an EKG, which the hospital lost and I have to have done again <groan>.
Tuesday of last week I get a call from the dr's office. They basically told me that IBEW called and told them that they wouldn't cover my surgery that the diagnosis (obesity) was not covered. Immediately my blood pressure went up.. I could feel it! Fortunate for me I had done my homework. I pleaded with the dr's office NOT to cancel my surgery date, while I called to straighten it out.
When I called the IBEW, the woman told me the same thing.. that obesity wasn't covered, UNTIL I told her to go to page 33 of the handbook which states "no benefit will be paid for treatment of obesity (including prescriptions) with the exception of surgery in cases of morbid obesity". She never knew it was there and I was the first person in the plan to have this surgery. So now I ask her what I have to do and next thing I know I'm calling all my dr's to get them to fax all my information to IBEW so they can send it to the medical review board for approval which can take WEEKS!! Fortunately what ended up happening was that they spoke to the carrier MULTIPLAN and when they found out that they had deemed it a medical necessity, I didn't have to do anything more. They sent out my precertification to my dr. stating that they would pay $5913.60 (my coverage) and another $5913.60 (my spouse's coverage.. we work for the same company). The surgery will cost $12,000.00, so we'll only have to come up with about $200.00.
Needless to say.. I am soooooooooooooooooo relieved!! Thank you all for your continued support, prayer and love! Not long now..!!!
And a very special thanks to my Angel Crow! *kisses*!!