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Denied after being approved and devastated

Panda333

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GrungeGrownUp    10

GrungeGrownUp
Posted

On 9/4/2019 at 4:27 PM, Panda333 said:

Hello, I'm the original poster - Latest update. Well last week I raised such cane with my dr's office and the insurance company. I decided to take control rather than let them rule my life. Today I get a call from the insurance company. They received my appeal and did research. it turns out there were some errors in the plan docs which caused confusion. They said "Congratulations!" I am covered and it DOES not have to be an IOQ, although they prefer it. Whoo hoo. But then they told me I had to get with my dr's office to tell them to resubmit with the clinical information showing I went through all of the steps. So I happily sent an e-mail to the business office and told them what to do. I blind copied in my surgeon because I just don't trust them.....(They were so quick to give up on me) I told them to kindly re-submit and gave them the person's name (RN) to reference. I basically hand delivered their job.....happy, I went on with my day....

then......... 5 minutes later........

The insurance lady I just spoke to called me back...and said...Oh I meant to tell you..... I did mention your surgeon and hospital doesn't have to be an IOQ but if an IOQ is available in your geographic area you have to use them. I went to my handy google maps. IOQ is 6 miles from my house but the surgeon I selected and have already paid $4200 is 28 miles. So.....I guess there is a chance insurance could deny again.. The funny thing is when I was first searching for doctors, I checked out Orlando Health (the IOQ) and they never called me back.....

arghhhhh...the confusion and agony of waiting. Meantime the hurricane was coming and i have been stress eating here in Florida.

Thanks for listening...

Orlando health? I have aetna a d an trying to user Dr. Smith at Advent Health in Celebration. How did this work out for you? A friend used Orlando Health and she hated the office staff and told me not to use them if I didn't have to.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
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    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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      1. This update has no replies.

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