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$65,000 Nightmare

Hello everyone,

I started my sleeve journey in August, when I was told my insurance company required 6 months of work with a dietician, as I'm sure a lot of people here have experienced or heard of. I did all that, jumped through all the hoops, and was sleeved March 7th. Fast forward almost two months, I just yesterday found out my insurance company does not cover the sleeve (??????) and I've now acquired $65K in surgery bills. I called the insurance company and the man I spoke to said they only cover diagnostic fees that come with it (whatever that means) and that was the end of that. I called the surgeons office in tears, and they said they'd never heard of anything like this, but that they got their money so the letters I received from my INS company must be "erroneous". After speaking with them today, they told me that even though the insurance company had reimbursed them, they just found out today that they are asking for the money back, and that they are going to appeal it. WHAT DOES THIS MEAN?! Has anyone ever had any problems of this nature? I went from only owing $2500 in deductables to $65,000!! I could've gone to Mexico and had a sleeve vacation for $10K! I am so beyond upset right now, and feel like my insurance company is trying to ruin my life. Please, any advice/stories/knowledge would be greatly appreciated.

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  • Time to lawyer up

  • Wheetsin
    Wheetsin

    This is a really sticky situation. At the end of the day, the patient has responsibility to pay for any services rendered - so first, do not accept insufficient explanations from your insurance compa

  • Giselle3264
    Giselle3264

    I'm sorry to hear how this is stressing you out. I worked for a health insurance company for many years and, yes, they can rescind payment. HOWEVER authorization is often done using ICD-9 codes so if

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I like Mab's idea....no one likes to go under the public microscope....do a little leg work and call a few local news stations. Sorry this is happening to you.

At least call a lawyer for a consult (one who has experience with medical insurance)...if nothing else, they can give you some advice. Sorry you're dealing with this.

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