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Didn't get pre-auth before surgery. What are the chances Insurance will pay?

shrinkAdink_05/10

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shrinkAdink_05/10    4

shrinkAdink_05/10
Posted

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.:rolleyes: 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!!:rolleyes:

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
    • KimBaxleyWilson

      KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
      · 0 replies
      1. This update has no replies.

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