1 pound 2 ounces cost me $9,000 Seriously

[WalkOnWaking 139]

Dropping below 35 BMI will not negate approval, at least with policies I have read. It was the start of the process to gain approval (usually 3 or 6 months supervised medical weight loss attempt).

[jembell01 129]

Sent your receipts in to Aetna for a claim. Insurance will reimburse you or they should at least give you back some of your money

[RonnieRab 31]

You need to fight this! Get a lawyer if you have to.

[lwmatch 31]

Hmmm....and unless you speak with the ins ppl you will not know if they also collected money from them in addition to what they took from you.

Talking with the hospital nurse/ filing person, no claim has been sent in yet, regarding the hospital stuff, but then again the last letter I got from Aetna, 12/30 said the sleeve and the 2nd day of hospital was approved for Dec. 16th. WTH how would they know I stayed a 2nd day if they didn:t file anything. Grrrrrrrrrr.I wish you 'smart' people were close so I could take ya'll with me! So the $3000 sleeve at the moment stands at $12,700. I might need bailsbond person on speed dial when I go there Tuesday. I am leaving my nice boy britches at the house.

[Wonderkind 23]

I am just so sorry that they are dirty cheats! Get 'em!

[lwmatch 31]

I am just so sorry that they are dirty cheats! Get 'em!

lol, you bad, Thanks!

[Steph Anie 72]

I was worried about the same thing and I was told my insurance only used our beginning weight b/c they wanted to see us losing and were not going to penalize us for it. Everything should have been approved prior to surgery day--this sounds way shady.

[lwmatch 31]

Thanks Steph, who is your Insurance. I told Cindy if surgery done at 7:30 a.m. as scheduled would of been fine, no done at 5:30 p.m. No drinking or eating two days, extra pee break got me. Official weight wrote down 256, needed to be 258. She pulls corporate policy out, I guess I need denial letter in hand

[Mistie 201]

To clarify, and correct me if I am wrong, this has nothing to do with insurance. The hospital has not said your insurance will/will not pay (and you have proof you are approved). They are saying it is HOSPITAL policy that all clients under x BMI must self-pay.

That's a very strange policy, first off. Second, their own alterations to the schedule is what caused your problem. You were an adequate BMI upon entering the premises - it was their lack of prompt, adequate medical care (ie. Delayed) which resulted in a lowered BMI. In my estimation, that means the responsibility is theirs, not yours. And third, I think it could be argued that since you obviously have approval, they submitted to insurance in good faith with the intention of proceeding with the BMI listed in file - using an alternate BMI would seem to be fraud, as that is not what they represented to the insurance company.

Again - contract with insurance company means they must accept it if a patient has it. They do not get to pick and choose.

And no, I'm not a lawyer. I didn't even sleep at a Holiday Inn Express last night

[lwmatch 31]

To clarify, and correct me if I am wrong, this has nothing to do with insurance. The hospital has not said your insurance will/will not pay (and you have proof you are approved). They are saying it is HOSPITAL policy that all clients under x BMI must self-pay.

That's a very strange policy, first off. Second, their own alterations to the schedule is what caused your problem. You were an adequate BMI upon entering the premises - it was their lack of prompt, adequate medical care (ie. Delayed) which resulted in a lowered BMI. In my estimation, that means the responsibility is theirs, not yours. And third, I think it could be argued that since you obviously have approval, they submitted to insurance in good faith with the intention of proceeding with the BMI listed in file - using an alternate BMI would seem to be fraud, as that is not what they represented to the insurance company.

Again - contract with insurance company means they must accept it if a patient has it. They do not get to pick and choose.

And no, I'm not a lawyer. I didn't even sleep at a Holiday Inn Express last night

It appears the Hospital is smarter than I gave them credit for. When I called Aetna yesterday evening to talk with them, they are like no if ands or buts if bmi goes below 35 even with co morbities. Wasn't their fault or concern my surgery was delayed that day, not their fault I dropped 2 pounds below my 35 bmi. I feel where I am at now, to get Dr. and hospital to file and when I get the Aetna denial letter, to educate myself better on the process of filing an internal and or external appeal. Appears this hospital had dealt with the Hard hearted Aetna people before. And rightfully so, covering their _ss.

[BobbyD 211]

I got tired of arguing with my insurance, bit the bullet and paid for it myself. I think of it as a car payment for 3 years. In the whole scheme of things, I'd rather be healthy rather than riding around in a new Buick. Sometimes we have to deal with life on life's terms.

[NikkiDoc 312]

They should still file the claim. Just because the customer service rep has a cheat sheet that says not below 35 BMI does not mean that once the actual examiner reviews the claim and your medical history that is what the determination will be. The cheat sheets the CS reps rarely have every little detail.

I do find it odd they did not weigh you immediately at check-in. That was the first thing my facility did with me still dressed in street clothes. Heck if I got that run around I would have been borrowing hubby's winter coat to re-weigh with or had them recheck my height and slouched a bit.

Heck I used to be 5'4" in high school. I now measure at 5'3" 30 years later. It is common to lose height as you age.

[lwmatch 31]

They should still file the claim. Just because the customer service rep has a cheat sheet that says not below 35 BMI does not mean that once the actual examiner reviews the claim and your medical history that is what the determination will be. The cheat sheets the CS reps rarely have every little detail.

I do find it odd they did not weigh you immediately at check-in. That was the first thing my facility did with me still dressed in street clothes. Heck if I got that run around I would have been borrowing hubby's winter coat to re-weigh with or had them recheck my height and slouched a bit.

Heck I used to be 5'4" in high school. I now measure at 5'3" 30 years later. It is common to lose height as you age.

[lwmatch 31]

Thanks for that. The nurse allowed me to redress but Didn't realize my magic go home number was anything less than 258. I weighed 256.8.

[lwmatch 31]

I got tired of arguing with my insurance, bit the bullet and paid for it myself. I think of it as a car payment for 3 years. In the whole scheme of things, I'd rather be healthy rather than riding around in a new Buick. Sometimes we have to deal with life on life's terms.

Yea, I understand. When I started this journey, A surgeons office in Houston said no way for insurance. Talked to people in Victoria, Texas and they led me to a direction of hoop jumping and was approved. I had already borrowed the money and had put back for cash pay, so imagine the satisfaction of getting the approval letters. So when in pre-op in my gown when confronted with cash pay or no way, as you did, hell or high Water I needed the sleeve and got it. As Nikkidoc stated, just because a phone person says no, is no reason not to submit the claims.