I have been going through the process for the VSG since April. The first step was getting insurance coverage information. When my dr office talked to the insurance company they were told that my insurance company would cover the surgery and gave them the requirements. I have since had multiple visits with my surgeon, nutritionist, classes, EGD, 2 psych consults and sleep study. I have a CPAP machine now as well.

I decided to give my insurance company a call since we were still waiting for the approval, just to check the status. I was informed this afternoon that my surgeon was given wrong information and that surgery is not covered under any circumstance and not for any reason. I was completely flabbergasted. I missed work, had one hour drive time each way for all of my visits, I owe hundreds in co-pays for everything, etc.

The manager I spoke to said that she is going to pull the phone conversation to see what was said to my dr office during the initial call, but I am very nervous that it doesn't matter and they won't make an exception. She did say that sometimes they will make exceptions when mistakes are made but I am so worried they won't.

I have worked so hard and been in the process for so long and now I just feel completely defeated. I have no idea what to do. They said they would call me back on Thursday to let me know what they found out. I am going to be praying A LOT until that phone call comes.

Has anyone ever experienced this???

Jen

Awesome news! They should rectify the mistake. Hang in there, you're much closer to the end!!!

Good luck and please let us know. I can't imagine the stress you must be under over this.

Keep us posted.Pray everything works out.

Keep us posted

I feel like I am in the middle of a nightmare! So, I finally got ahold of the lady who called me and we discussed the claims that were filed up to this point. She asked if I wanted those claims to be paid and I told her that I wanted the surgery covered that they told me was a covered benefit. She told me that she didn't think that would happen because the mistake was caught before the procedure. She put it to the claims exception committee and before the day was over I received a phone call back telling me that not only was the procedure not covered, but they were also not covering any of the copays or out of pocket costs from all of the pre-op work I had done. Even though I would have never had those medical expenses if I hadn't been pre-approved for the surgery, they didn't care. They said the claims were paid according to my coverage and I am stuck with hundreds of dollars of out of pocket costs.

I told her I wanted to know what to do next and she told me that I could appeal it so I am going through that route now and I have also contacted an insurance attorney to see what my options are.

I want to cry.

I am so sorry this is happening! You are on the right track with an appeal and an attorney. Good luck! Hang in there! Hugs!

I wish I had something profound to tell you. The best thing I could say is hang in there. You are giving it the best fight you have, and that alone is commendable! I wish you the best!

I'm so sorry. Really it's getting complicated!! I'll pray for u. Keep us posted.