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.

Once the surgeon files the claim, the insurance company will pay him the agreed upon fee. This is done monthly. They will also recoup the fee you paid to the surgeon (subtracting it out of the total payment) and will reimburse you.

If you file the claim, it can start the investigation into why the surgeon did not do the correct and legal thing per his contract.

He was following the Hospitals lead when they said they wouldn.t submit.

It doesn't matter what the hospital said or what the surgeon said. They are both wrong.

Because you are not well-versed in this subject, I still say you should call the customer service number on your insurance card and tell them you want to file a formal complaint against the hospital and the surgeon. Then explain that when you were in a gown, they suddenly decided insurance wouldn't cover the surgery (even though you had authorization) and demanded payment up front.

Tell them you need their help to get the hospital and the surgeon to file claims, because you've already given them $9,000 (or whatever the total was), and you need help.

Start a notebook and write down the date, the time, and the name of the person you spoke too, and some notes about the conversation.

It doesn't matter what the hospital said or what the surgeon said. They are both wrong.

Because you are not well-versed in this subject, I still say you should call the customer service number on your insurance card and tell them you want to file a formal complaint against the hospital and the surgeon. Then explain that when you were in a gown, they suddenly decided insurance wouldn't cover the surgery (even though you had authorization) and demanded payment up front.

Tell them you need their help to get the hospital and the surgeon to file claims, because you've already given them $9,000 (or whatever the total was), and you need help.

Start a notebook and write down the date, the time, and the name of the person you spoke too, and some notes about the conversation.

Very good, thanks so much. I go back next Tuesday and with suggestions here, got a lot better idea that things should go my way or at least understand how to present it better.

You were unfairly ambushed during a very stressful moment when you were extremely vulnerable. (practically wheeling into the OR)

​Your insurance company will assist you in rectifying this situation. Good luck and please keep us updated on the status.

You are not stupid and this is not your fault at all.

Speaking as an insurance provider, the hospital and doctor are both in breach of a formal contract they have entered into with the insurance company. They have agreed to provide services and accept a fee from the insurance company. They breached the contract by demanding and accepting an out of pocket fee from you. It is not legal - they must file and accept the insurance fee (which will be lower than what you paid, due to insurance contracts - hence this tactic). As well, this bait and switch, while you are in the gown and prepped for for surgery, therefore vulnerable, is unethical and I would say bordering on illegal. It's a lawsuit waiting to happen. And I dare say something they have done before. They may have a required bmi, but making a patient sit without food and Water, then weighing is a deliberate attempt to force them below the bmi so they can get an out of pocket fee.

Go to your insurance company. Explain what they did to you and the circumstances. The doctor and hospital need to lose provider status.

This sounds extremely shady. I'm curious if you made the check out to the doctor or the hospital. Because of the hernia repairs the OR and anesthesia were already being paid for. It's bizarre that someone came up with $9000 so quickly. And what surgeon knows that they're booked for a year out when they delayed you all day? I'm sorry but I think there is some moral and ethical issue here. I suggest you also call the hospital and ask to speak to the compliance officer. Please keep us updated and if you don't get anywhere there are still more things you can do.

Speaking as an insurance provider, the hospital and doctor are both in breach of a formal contract they have entered into with the insurance company. They have agreed to provide services and accept a fee from the insurance company. They breached the contract by demanding and accepting an out of pocket fee from you. It is not legal - they must file and accept the insurance fee (which will be lower than what you paid, due to insurance contracts - hence this tactic). As well, this bait and switch, while you are in the gown and prepped for for surgery, therefore vulnerable, is unethical and I would say bordering on illegal. It's a lawsuit waiting to happen. And I dare say something they have done before. They may have a required bmi, but making a patient sit without food and Water, then weighing is a deliberate attempt to force them below the bmi so they can get an out of pocket fee.

Go to your insurance company. Explain what they did to you and the circumstances. The doctor and hospital need to lose provider status.

Strong information, Thanks, you write exactly as I feel, The Bariatric Manager was new in her position but no one called her out on HER decision. I will talk to Hospital CFO next week and if they are him-hawing around waiting to see what the Dr. thinks,[Hello, they had told him they weren't filing] I am telling them I will be filing a formal complaint with Aetna. I will have the names of the Manager, CFO and Dr. office manager in my notes to be prepared. Thanks to all the great people here for listening and sharing.

When I got my approval through the insurance company, the paperwork said it would cover the procedure for one year. What did yours say? I would submit the bill directly to insurance.

When I got my approval through the insurance company, the paperwork said it would cover the procedure for one year. What did yours say? I would submit the bill directly to insurance.

Didn't see an expire date but last approval I received yesterday said Dec. 16th approved along with the 2nd day of hospital stay. It does say on the back many things such as if patient condition changes the approval may change.

Wow......this just smells bad any way you look at it. My insurance submission was based on the weight I was when I showed up for my first appointment at the bariatric clinic. Sounds like a lawsuit and punitive damages, too.

Maybe you could approach one of those lawyers who doesn't charge you unless they win their case. They won't take on a case that they don't think they can win. Document, document document. The one with the most documentation wins. While it is fresh in your mind, start a journal. You are going to need to recall the day to day progression of this disaster and who said what. Get names and go kick some a**. Hugs from Chicago.

Wow......this just smells bad any way you look at it. My insurance submission was based on the weight I was when I showed up for my first appointment at the bariatric clinic. Sounds like a lawsuit and punitive damages, too.

Maybe you could approach one of those lawyers who doesn't charge you unless they win their case. They won't take on a case that they don't think they can win. Document, document document. The one with the most documentation wins. While it is fresh in your mind, start a journal. You are going to need to recall the day to day progression of this disaster and who said what. Get names and go kick some a**. Hugs from Chicago.

Thanks so much! I go back next Tuesday, 1 1/2 hour one way, and thanks to all of you, no offense but I have some bigger b_lls now. lol.I am out a total of $9700 that I shouldn't of had to pay. And I will DEFINETLY keep my new friends here updated!

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.

lwmatch,

I am SO SORRY to hear this! That’s just despicable. The only thing I can think of to offer is: do you have any weigh-ins on record of being over BMI 35 at the time you got insurance approval? I just don’t know what to say. I am floored.

lwmatch,

I am SO SORRY to hear this! That’s just despicable. The only thing I can think of to offer is: do you have any weigh-ins on record of being over BMI 35 at the time you got insurance approval? I just don’t know what to say. I am floored.

Thanks Alex, great website with great group of people and a ton of information! I have monthly documentation starting in July,from my primary care, my bariatric Dr. office and my 2 week pre op, AT THE HOSPITAL Always right at 262 lbs. at 6 ft. tall. with co morbidities documented. Day of surgery only time ever below my 262, cause I knew I needed to maintain the weight for approval, I thought. Day of surgery after being delayed until 5p,m. no Water now for 24 hours, 256.8 at a 34.8 bmi.

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).