So the first thing I did was call my insurance (humana) last fall to find our what my coverage for surgery was. They told me its covered at 90/10 as long as you meet the criteria. Lady sends me a info sheet. I meet the criteria. I make my appt, go through all the steps. MD office submitted for pre-approval and I was approved within days. Had my surgery in January. Now am looking at claims online and finding most of them are denied. Called Humana...oh well, there is a MAX OF 10K lifetime for obesity coverage!! What?? This is the first I have heard of it. Called hospital billing and they will discount a certain portion for being cash pay, but still will owe around 30k. I feel like a total idiot here for not going over this with a fine tooth comb. Maybe I am expecting too much from my doctor's office, but I certainly thought they would have mentioned this to me when they submitted for approval. I am just beside myself. And certainly I should have been told when I called Humana. Husband looked it up and it is in the fine print of our policy. I am just so upset. Trying to look on the bright side and look at this as a huge investment in my future, but 30K??! Thanks for letting me vent.

So that is really crummy, but on a note that might make you feel better, most places will work out a payment plan with you so that it doesn't break the bank and they still get some money out of the deal. It might take forever to pay off, but it's not like the interest on credit cards, so what you pay goes toward knocking down the full debt as opposed to just keeping the creditors at bay.

Also, you might contact an attorney. The procedure they performed was not an emergency procedure so if they had done their due diligence everyone would have known what the cost to you would have been.

Pay the least you can.....let it go for fifty years if you have to.

Yes, consult a lawyer and take Miss Mac's suggestion. There's a big difference between going hungry because of high monthly payments and eating less as a result of surgery. You want to be minimally inconvenienced by payments.

I know nothing about arbitration, but it might be an alternative for you to consider.

Some hospitals offer financial assistance.

If you asked for your benefits and the rep didn't include the lifetime max when quoting, call your insurance and complain. Tell them you want to appeal based on being misquoted your benefits. I worked cs in health insurance for years and misquotes got approved quite often.

Sent from my XT1565 using BariatricPal

Laser girl 75 I agree. Great info!

Sent from my iPhone using the BariatricPal App

File a grievance and appeal because if someone gave you the wrong info they have to help you I use to work for Humana

If you asked for your benefits and the rep didn't include the lifetime max when quoting, call your insurance and complain. Tell them you want to appeal based on being misquoted your benefits. I worked cs in health insurance for years and misquotes got approved quite often.

Sent from my XT1565 using BariatricPal

This. There have been other instances here of similar happenings. File an appeal. Use a phrase like, "their rep enticed you to obtain discretionary surgery by misquoting the benefits, and you relied on that benefit quote to guide your decision to obtain surgery."

Ask them to pay it as quoted.

Thanks all. I called the insurance and asked about an appeal, and the guy looked back at the notes form when I called them in September and said that the notes say that I was informed of the 10k max. Now if I was, I certainly don't recall it. Maybe it didn't register in my old brain. I don't know.

I called the doctor's office billing person, and they said that they were not aware of the 10k max from my insurance. How is that possible??

I also asked if I could just ask Humana to revoke the claims and do self pay, since that would be cheaper at this point. She said no, that it would be insurance fraud since I already had the procedure. @@number1rudegal and @@losergrl75 do you know if this is true?

Thanks all. I called the insurance and asked about an appeal, and the guy looked back at the notes form when I called them in September and said that the notes say that I was informed of the 10k max. Now if I was, I certainly don't recall it. Maybe it didn't register in my old brain. I don't know.

I called the doctor's office billing person, and they said that they were not aware of the 10k max from my insurance. How is that possible??

I also asked if I could just ask Humana to revoke the claims and do self pay, since that would be cheaper at this point. She said no, that it would be insurance fraud since I already had the procedure. @@number1rudegal and @@losergrl75 do you know if this is true?

What you can do is ask to speak with a supervisor and have that call played back because all call are recorded and yes it's true you can have a claim revoked

Thanks all. I called the insurance and asked about an appeal, and the guy looked back at the notes form when I called them in September and said that the notes say that I was informed of the 10k max. Now if I was, I certainly don't recall it. Maybe it didn't register in my old brain. I don't know.

I called the doctor's office billing person, and they said that they were not aware of the 10k max from my insurance. How is that possible??

I also asked if I could just ask Humana to revoke the claims and do self pay, since that would be cheaper at this point. She said no, that it would be insurance fraud since I already had the procedure. @@number1rudegal and @@losergrl75 do you know if this is true?

There is no law that says you have to file a claim to your insurance. A person can choose to pay out of pocket for medical expenses without filing it to their insurance. I've done that before when I went to an MD for the purpose of obtaining diet pills and didn't want the visit showing up in my records. If the claim has already been submitted and the insurance has paid their portion, I'm not sure what the MD would use for their withdrawal reason (never had this situation come up). Maybe that is where they feel the fraudulent part would come into play. I wouldn't give up on your insurance company though. Call back and ask if the call was recorded. When quoting benefits reps typically copy and paste them into their notes, so it's possible for them to be in the notes but not have been quoted.

Sent from my XT1565 using the BariatricPal App

I am sorry about your situation. But I promise you have help a lot of people. Including me... Getting ready to look at my policy.. It's a shame because cash pay is not 30k. It's half that!

Sent from my iPad using the BariatricPal App

Don't forget the tax benefit too! There are so many items you can write off, including food post op

Sent from my iPhone using the BariatricPal App

Thanks all. I called the insurance and asked about an appeal, and the guy looked back at the notes form when I called them in September and said that the notes say that I was informed of the 10k max. Now if I was, I certainly don't recall it. Maybe it didn't register in my old brain. I don't know.

I called the doctor's office billing person, and they said that they were not aware of the 10k max from my insurance. How is that possible??

I also asked if I could just ask Humana to revoke the claims and do self pay, since that would be cheaper at this point. She said no, that it would be insurance fraud since I already had the procedure. @@number1rudegal and @@losergrl75 do you know if this is true?

Don't take their word,for it... he cannot prove you were told...did you sign something? Have them prove you were told... if they cant....seek an appeal.

Sent from my SM-G900V using the BariatricPal App

Absolutely you should appeal the denied claims, and you might consider filing a complaint with your state department of insurance. It's worth a try and you just might win. Humana does record many of their calls for this very reason. Ask to hear the recording.

Sent from my iPad using the BariatricPal App