Insurance Denying Coverage of Surgery Scheduled in 3 Days Based on Assumed Alcohol Consumption

[sblissp 16]

So I'm THREE days away from my surgery...more than a year into this program.my surgery is covered by my state insurance and I have complied to every criteria they have laid out. 6 months of nutrition classes, endoscopy, psych testing, quit smoking, don't do druids, don't drink, gave up coffee, lost 49 lbs, got the IVC filter...and 4 days before the surgery, they decide because I mentioned once in one of my many doctor visits in the past 6 months that I drink occasionally, that I did not follow the criteria for my state to cover the surgery. The thing is. I haven't had a drink, but I have consumed alcohol at random points in my life...weddings...party...once in a blue moon. I had to practically beg the lady at my state insurance co to believe me and I got an "I'll email the decision team and we will let you know." For real? Can this be before I start the Clear liquids diet on Wednesday and are you trying to test me??? Ugh. Thanks for letting me vent.

[ForkAndMindy 67]

That's insane! I'm so sorry :-( :-( I'm waiting to hear from my insurance company. I hope they reverse their decision for you! Keep us posted

[butterfyeffect 257]

That's awful! I think they just look for any excuse to deny you. You're doing the right thing by appealing the decision, if they have nothing to base it on other than a comment you made they'll have to overturn it!

[SnohoGal98296 371]

I would ask your surgeons insurance coordinator and your psych Doc to go to bat for you.

I have always asked about that question on med docs, because of this exact reason. If you respond yes to the "Do you drink?" question it sounds like your an alcoholic even though you are only having maybe 1 beer a week or just at social occasions! It is the way they ask it, there is no way to say sometimes, maybe once every two months, I have two drinks at a party but nothing imbetween...

I just shared this during my psych evaluation and told her I hate that question for this very reason. She explained that she understood that I only have a drink or two every once and awhile, and that they were trying to identify those who were drinking excessively. She shared that a recent patient was drinking two bottles of wine every night at dinner and didn't get that it was an issue for weight loss surgery.

In any case, if they are going to accuse you of being an alcoholic, they better have more than stupid question to go on!

Maybe even your state insurance representative could help, here in Washington our guy is a hero because he goes to bat for individuals all the time. One woman was denied coverage because her ex boyfriend beat her up, some stupid clause was referenced, it was huge in the news, the insurance company backed down and paid her claims. ..

[sblissp 16]

I appreciate your responses... I still have not heard from my insurance..surprise surprise.. my surgeon's team says that my insurance only says I can't abuse alcohols or drink regularly. So they want to fight it on that. I'm just in shock and can't believe they waited until 3 freaking days before, to tell me they have an issue. How do I find out if I have a or who my state insurance representative is? Like an advocate? I have a case worker but they never let me talk to the. I don't even know who it is. Very small town, plus, I'm the first person in my area to get bariatric surgery on state insurance. So I should have seen this coming.

[SnohoGal98296 371]

This person would be a state level person, I would search the name of your state and "insurance commissioner" or try variations of that doesn't work.

http://www.insurance.wa.gov is the website of the Washington state guy, don't know where you are. ..

Edited March 20, 2014 by SnohoGal98296

[Susysleever 265]

Really? Any excuse to deny. Any.

[sblissp 16]

Oh yeah it gets better. Insurance finally decides to take my surgeon's word for it that I wasn't admitting to current alcohol use during the program...but now, today...Wednesday, dat one of the clear liquid diet...two days before my surgery, my insurance informs me that they want me to do a urine nicotine test that takes two days to process. I learned this 20 mins before the lab closes so I have to do it tomorrow morning. This is utterly ridiculous. Why would they go as far as to pay for all of these procedures, including the IVC filter last week, to pull all this just days before the surgery. I live in Southern Oregon. 2 hours south of the hospital. So if I don't get the all clear by 5pm tomorrow, I'm guessing my surgery is off for now.. just the way they want it.

[Susysleever 265]

Sbp..I am so sorry. A nic test? They are sure trying. Bastards.

[Seela 1,187]

OMG! Your story saddens me and pisses me off. I am so sorry that you are going through this. I hope after jumping through all the hoops you get your surgery and I pray for a great recovery and rapid weight loss!

[cutiepieinchi 158]

I hope everything works out for you!

[sblissp 16]

Well I took the nicotine test this morning and even though I can go to Wal-Mart and buy one that will tell them I'm nicotine free in five minutes, they insist on the 48 hour one and refuse to approve the surgery until they get the results. Since the results won't technically be available until Monday, my surgery that was all scheduled for tomorrow morning at 7:30am has been postponed to whenever the check they feel like stop discriminating against me. :/

[ForkAndMindy 67]

Ohhhhh my god, that's crazy!!!! I would be SUPER pissed!!! I'm so sorry ????

[sblissp 16]

I don't even know what to think...I gave up a job opportunity at freakin Etsy for this!! I'm filing a grievance with my insurance and the state's health care plan..but that won't do much..others have it much worse and I will hopefully still get my surgery.

[Schmincke 118]

I am SO sorry to hear of the tough time you have been going through!