The good news, got sleeved on December 16th, including 2 hernia repairs. Doing good after I got off of protein shakes at two weeks. Had diarrhea for 9 days, developed a lactose intolerance.
Now the kicker. Got approval thru Aetna for the hernias and sleeve. The sleeve I felt was needed due to constant back pain and knee pain. And yes, lost 25 pounds already and only needing hydrocodone, once in last ten days, yea!
My sleeve was postponed from 7:30 a.m. to 5 p.m. Since the day previous and the day of surgery, had nothing to eat but a little water the previous day, I dropped below the bmi of 35. Hospital WOULD NOT allow sleeve to be done charged to insurance. I am in my gown in pre-op in tears because I felt I really needing this done. 1.2 pounds light, really. Dr. said no more openings the rest of year and would of cost me more if I reset after the first of year, due to deductions starting over. I was able to pay the out of pocket additional amount of $9,000 after two weeks earlier paying $3700 which should have covered my insurance deductible. I contacted Aetna after getting home and lady I talked to said that doesn't sound right. I am trying to get hospital to submit claim to insurance, but I know Dr. will be p.i.a. because he has gotten his cash money. ANY SUGGESTIONS or thoughts, please share! I had read before that once insurance approves that they don't care and hope you lose weight, to make the surgery easier. I know this is all the doing of the hospital and really is upsetting me.

No suggestions here. All can say is:

1- WOW!

2- Congrats on the surgery, nonetheless. Here's to hoping an improvement in health and happiness!!

3- I am incredibly sorry to hear this happened to you. I would be LIVID had this happened to me. Especially since I personally wouldn't have been able to fork out the remainder of the cost and would have needed to postpone to a later date. Hopefully the surgeon will be cooperative and at least submit. Even if denied- he already has his money. So what will/can this hurt him?

Edited January 8, 201610 yr by sassyfrass23

Can you submit to the claim to your insurance company? Call them and ask. I'm hoping you have receipts to submit. If it was already approved by your insurance the BMI shouldn't factor as most of us go on the pre-op diet to help shrink our liver and that results in weight loss.

I would also report to everyone about this if its not resolved.

Thanks for sincere reply. I do not have the easy $9000 answer!

If the facility and surgeon are in-network with your insurance, they must submit the claims. Its in their contract with the insurance company.

If the facility and surgeon are in-network with your insurance, they must submit the claims. Its in their contract with the insurance company.

This. 100%. Every health insurance contract I've ever seen requires this. Tell both the surgeon and the hospital that you expect them to file your claim within five business days (put it in writing, certified mail return receipt). They've had enough time already to get it done. If they don't file, then make a formal complaint with your insurance company.

I don't see how the facility or surgeon can make the decision for the insurance carrier on if something is covered or not. This surgery requires pre-certification. Either you were approved or denied. The providers don't decide this!

Something sounds extremely off. Take this up with both the office manager at the Surgeons office, and the medical director at the facility. Don't give up or give in. Something isn't right if you made it to surgery prep in the hospital and not only do they then tell you insurance won't cover but your doctor also prayed on your moment of weakness by telling you no openings, more money, blah blah. That's some serious shady business. I'd be screaming BS from the roof tops on this one and would be making news headlines.

Edited January 8, 201610 yr by HopeandAgony

Where do you live? The more I think about it the more bizarre this story sounds.

His surgeon is in Victoria, Texas.

Advertise the Hospital and Dictor all over the site, maybe people will go elsewhere. Dispicable behavior.

Thanks for the reply. The response was that at the bmi I was the evening of surgery I didn't meet the Hospital requirements. Seriously. AND I REFUSE TO ROLL OVER ON THIS!

Something sounds extremely off. Take this up with both the office manager at the Surgeons office, and the medical director at the facility. Don't give up or give in. Something isn't right if you made it to surgery prep in the hospital and not only do they then tell you insurance won't cover but your doctor also prayed on your moment of weakness by telling you no openings, more money, blah blah. That's some serious shady business. I'd be screaming BS from the roof tops on this one and would be making news headlines.

Thanks for your support and helpful comments. As others posted, this seemed bizarre and down right shady. I couldn't or wouldn't fabricate a story as aggravating as this is. Just trying to figure which direction to push hardest on, the providers telling them I insist they file, or Insurance asking them to push. Latest info is waiting on Dr. to return off of vacation and the hospital CFO wants to talk to him and let him know I have requested the hospital submit bill and to see what he says.

That is so odd and seems so wrong. I wasn't even weighed again after I had gotten insurance approval. I weighed myself at home the morning of surgery but they didn't weigh me at the hospital. I'm not sure the doctor can dictate whether or not they file your insurance. Don't they have to do that? I would definitely get your insurance company to try to contact the doctor. Good luck and I hope it works out!

Yikes!

I would just call insurance and obtain paperwork to be reimbursed, just ask what documentation they need. Canceled check, receipt etc and submit for reimbursement

Good luck