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Didn't get pre-auth before surgery. What are the chances Insurance will pay?
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The problem is this...I made several calls to our Insurance company to let them know I was having LAP-BAND® surgery and the person said it was covered. Well, I didn't believe them. I figured the person was new, or didn't know what LAP-BAND® surgery was, so I called again a few days later to get a new person and ask the same questions. This person too said, "yes, this surgery is covered" This person was even more helpful giving the link for the pre-surgery requirements all of which I met except for the psych eval. They even gave me the link to print out the form to file with the insurance company since the doc I was using did not file with insurance and wasn't in the Blue Cross Blue Shield network. I was self pay in the amt. of $9875. which includes 3 months post op. After that he only charges $25 for fills. During the surgery he did find that I had a hernia and repaired that as well. Now that I have had the surgery, and before I have filed anything with the insurance company I find out that I was required to call in for a pre-auth for surgery. We just switched to Blue Cross from Aetna in January. Aetna didn't require pre-auth's (I had foot surgery and bladder surgery last year and never got a pre-auth, unless the doc did this for me??) So, now I am wondering if anyone has delt with this issue and what the outcome was? Any ideas on how to approach this when I file for reimbursement from the insurance company? I paid with a credit card and while I will be very disappointed if they won't cover anything...it is stll the best thing I have EVER done for myself and I would have still been a self-pay regardless.
My primary care physician said he will do whatever it takes to help me get this paid for as he has been treating me for the last 8 years for obesity with nothing but a yoyo effect. If you have any advice on how to approach this at time of filing I would GREATLY appreciate it! (Do you think they would even cover the hernia portion of the surgery??) THANK YOU IN ADVANCE FOR YOUR ADVICE!!