Question:
What can I do? approved by mistake
my insurance approved both my husband and I for lap rny back in July. Our surgeries were already set up. My husband goes in for his pre-op visit and the lady tells him the insurance company called and they are not gonna pay. They said they made a mistake in approving us to start with we did not send enough info. But, our approval letters say based on the info submitted you have been approved. Now they have cancelled our dates. Do you think we have a case are can they get by with this. Any info or suggestions would be great. I'm so sad and mad at the same time. Its not right. Thanks for listening. — jennie_jen (posted on October 4, 2003)
October 4, 2003
DO NOT GIVE UP!! I'm not familiar with your particular insurance and I
know that it is depressing when they do this, but they have to have an
appeal process and once they approve a surgery, they cannot just take it
away. Now, if they have a limit on how long an authorization is good for,
they can say that it ran out. The best thing you can do is to look at your
insurance policy and see if it states how long the authorizations are good
for. You can fight this, but I'm not sure I would get a lawyer just yet
because that could only end up costing you money. Try to resolve it
yourself. You would be suprised at what one person can do when fighting an
insurance company, just be persistant!
— tmchase62
October 4, 2003
Hi Jennie: How horribly unfair to you and your husband. I don't know if
it's illegal to say they approve the surgery and then recind the approval
or not. You can call and ask an attorney that specializes in insurance
issues. Usually they will consult with you over the phone for free. You
might not want to hire an attorney yet, but I sure would get their opinion
on if you had a case or not. Good luck, and I hope you get your approval.
— sherry hedgecock
October 4, 2003
Seems like you've over looked the most obvious question. Ask them why? It
may be something that you can fax to them and move on. Don't let the
emotions rise until you have all the facts.
— rleffler
October 4, 2003
I think this is really unfair to you but insurance companies can and do
this to people every day and it is perfectly legal. I wouldn't give up
without a fight tho. As a previous poster said, call them up and ask them
why. Maybe they only need something else from you. Good luck
— Delores S.
October 4, 2003
If you can't get the paperwork straightened out and you want to know if it
is legal for them to recind an approval, call the insurance commissioner's
office in your state.
— bethybb
October 6, 2003
They said they need the diet history and I do not have it. I haven't been
to my pcp in over 5 years. I contacted my insurance commissioner and yes
they have the right to recind so now what? They approved us based on what
we sent in. I guess this is over a year of my life wasted. thanks everyone
for your help.
— jennie_jen
November 23, 2005
Jennie W.,
I just read your post and I know that it has been a couple of years. In
you last post you said "I guess that I just wasted a year of my
life." I sure hope that you do not feel that way anymore. I hope
that God helped to answer you about the insurance and I hope that you and
your husband both got your surgeries. I have been fighting for over two
years to get mine and I am now about to change insurance companies and
start over. best of luck on your journey to a healthier, new you.
Heidi :-)WV
— Heidi P.
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