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Doctors Office And Insurance :(



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I started my journey in Sept. went to my first visit to surgeon after seminor. The very first visit they called my insurance co and they said it was covered except for 1000.00. So i started making appt with other doctors so i could have my surgery. Did my nutrition classes and all appts the doctors office sch my lapband and 4 days before my surgery they called me and said that the lapband is excluded from my policy. :( i have talked to the ins co nothing i can do. I have spent alot of money on the other appts that are required for the lapband missed alot of time from work unpaid. I have wrote a letter to the doctors office with no response. I have talked to one of the girls at the office but it didnt get me anywhere. Don't know if there is anything else i can do. It stinks have been so upset about this whole thing.

Michele

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Ugh geez that is so terrible! How can they do that to you? That is something they should have told you from the beginning, why a change all of a sudden? Do you have proof in writing that they approved you the first time with the $1000 copay? I feel so bad for you.

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I'm confused.

Did the first Dr. Tell you there was a $1000 co-pay, and the 2nd Dr tell you that you are not covered at all?

Each office has a staff that submits claims and get insurance approvals.

Every office is different, and some are good at this and some are not.

It can sometimes come down to using one single wrong word that raises a red flag and results in a denied claim.

I know. In my field we rely on insurance reimbursements and the girls in my office are very good. They manage to get pre approvals and good reimbursements from the same insurance companies that other people cannot!

Unless your policy has changed, I would say the 2nd Dr's office does not have a talented staff.

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Iam getting cold feet about my surgery. I had to go through 6 months of dieting for the insurance to approve my surgery. I have loss 33 lbs on my own.. as any diet I am getting tired of the restrictions and over the holidays have gained 4lbs back. So it makes me want the surgery but at my age 55 and 198lbs with a BMI of 30. Will I be happy or sorry I had the band. I have been reading different Bloggers and I don't hear satisfying comments.. who loves the band? Is it safe?

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Band is limiting if done properly...restrictions on foods with skins at first (corn, grapes, tomatoes..). No meat, no bread, cant eat or drink at the same time...at least thats how my moms was and she lost 89lbs over a year

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I had something similar happen to me last year.

I was covered under an employee Regence BCBS plan, and Oregon Weight Loss Surgery sent me a letter stating that I was covered and the level of coverage, copay, etc. I wanted to verify myself, so I called the insurance company and was told there was no coverage. I explained to the insurance company employee that I had received a letter with benefit breakdown and asked how it was possible. She then did a three way call with her, myself, and the insurance coordinator for Oregon Weight Loss Surgery and come to find out the OWLS coordinator saw I was under a Regence Employee Plan and ASSUMED I was on the plan that covered bariatrics without actually checking. Needless to say, I am now under a new insurance that does provide coverage and will not be going to OWLS because the coordinator didn't even apologize for the mistake. Talk about a total let down...

I have a feeling this also happened to you :(

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I'm confused.

Did the first Dr. Tell you there was a $1000 co-pay, and the 2nd Dr tell you that you are not covered at all?

Each office has a staff that submits claims and get insurance approvals.

Every office is different, and some are good at this and some are not.

It can sometimes come down to using one single wrong word that raises a red flag and results in a denied claim.

I know. In my field we rely on insurance reimbursements and the girls in my office are very good. They manage to get pre approvals and good reimbursements from the same insurance companies that other people cannot!

Unless your policy has changed, I would say the 2nd Dr's office does not have a talented staff.

It was the same doctors office that told me in the beginning that all was covered but my co pay and then 4 days before they called and said it wasnt.

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It was the same doctors office that told me in the beginning that all was covered but my co pay and then 4 days before they called and said it wasnt.

Well that just blows! They obviously made a mistake big time.

Unfortunately there is nothing you can do. Wether they admit to the mistake and apologize or not, they are not going to do the procedure unless they know who is paying for it.

I guess the only thing you can do is speak with your insurance yourself and try to work out with them.

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Iam getting cold feet about my surgery. I had to go through 6 months of dieting for the insurance to approve my surgery. I have loss 33 lbs on my own.. as any diet I am getting tired of the restrictions and over the holidays have gained 4lbs back. So it makes me want the surgery but at my age 55 and 198lbs with a BMI of 30. Will I be happy or sorry I had the band. I have been reading different Bloggers and I don't hear satisfying comments.. who loves the band? Is it safe?

Dear Jane, I LOVE my band! I am 48 years old and was 215 pounds so I had to self pay...life is fantastic now...I wear a six!

Casey, I dont know what your Mom's story is but I can and do eat everything and have none of those issues...I just eat a lot less!

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Wow that is insane. When I went to my very first seminar, they gave me a huge packet to take home. In that packet was an Insurance Info packet. It gave me complete directions on calling my company (Highmark BCBS) and asking them if certain codes (medical codes) were covered. I verified that Gastric Banding as well as gastric bypass were all covered. Even though my plan never changed, I was paranoid and called almost every month asking if the same medical codes were covered. Now if they would just hurry the hell up and approve me. I am so sorry that u had to go thru all this. It is a shame. I can't believe how un-educated people are in their own jobs. Almost every insurance comapny has multiple types of plan. She should have known that not all insurance plans within a certain company are the same. Shame on her...nonod.gif

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