Help! I don't know what to do!!!!

[Kate228 0]

Ok...I was told by my surgens office on May 14 that my insurance approved the surgery and I even called on Friday to make sure all was ok with the insurance and I was told the same thing...it was approved.

I recieved a letter today ( Saturday) from my insurance company saying that b/c my BMI is below 40 I need to have a disease or disorder ( not in those words but you know what I mean) to qualify and that it was DENIED! It was dated May 13, the day before I was told approved.

Is it possible that I originally got denied and the Dr.s office appealed it and I'm getting the first denial letter now? I don't know what to think? My surgery is on Monday morning and I can't get in touch with anyone!!!

What do I do?????:confused2:

[WestCoastFatGuy 3]

Ok...I was told by my surgens office on May 14 that my insurance approved the surgery and I even called on Friday to make sure all was ok with the insurance and I was told the same thing...it was approved.

I recieved a letter today ( Saturday) from my insurance company saying that b/c my BMI is below 40 I need to have a disease or disorder ( not in those words but you know what I mean) to qualify and that it was DENIED! It was dated May 13, the day before I was told approved.

Is it possible that I originally got denied and the Dr.s office appealed it and I'm getting the first denial letter now? I don't know what to think? My surgery is on Monday morning and I can't get in touch with anyone!!!

What do I do?????:confused2:

Is there an answering service for emergencies at your doctor's office? If not, the only thing you can do is show up for surgery as planned and confirm with the doctor (in writing) that the insurance has approved you. It is, indeed, possible that the surgeon's office found that the insurance originally denied you.. but they sent in another request with additional information that included co-morbidities.

If the surgeon is unable to confirm that you are approved... you will have to reschedule so as to ensure that you are not on the hook for the full amount.

I am sooo sorry that you are experiencing this stressful situation so close to surgery. Just try to remind yourself that no matter what happens.. this is just one of the steps in your journey. It may be a rocky, slippery one... but one of the steps, nonetheless.

You have been very strong to get this far... you have the strength to see this through to achieve your goal! We are ALL behind you!

[favorite 3]

your surgeon must have an emergency number for you to call. or call his regular number and tell whoever you talk to your situation. if there is just a machine leave a message about whats happening they probably screen the calls for true emergency situations. i think (and hope) from what you wrote that you got approved after they reviewed your situation and you received that letter before the review. in any event if you cant get in touch with anyone i would definately show up ready for surgery. tell them when you get there and before they operate on you they will make sure with the insurance company that all systems are go. i am really sorry you are going through this. what a royal pain in the butt right before surgery.

[Froggi 4]

Hope things work out.

[Kate228 0]

Thanks all of you for being a calming force when I'm full of stress. It really does help!

So I had the Dr. paged and he called me back. I told him the story and he called the women who handles the insurance claims in his office and then called me back. He said that she is insisting that its approved but he is going to delay my surgery to 11:00 a.m instead of 7:00a.m. to make sure all is ok with the insurance.

When the Dr's office is given an approval, isn't there a reference number or approval number that goes with it? I'm really hoping that its just a mixup and everything will go smoothly on monday.

[HF2008 0]

Who is the insurance through?

[Kate228 0]

United HealthCare through AIG

[WestCoastFatGuy 3]

Thanks all of you for being a calming force when I'm full of stress. It really does help!

So I had the Dr. paged and he called me back. I told him the story and he called the women who handles the insurance claims in his office and then called me back. He said that she is insisting that its approved but he is going to delay my surgery to 11:00 a.m instead of 7:00a.m. to make sure all is ok with the insurance.

When the Dr's office is given an approval, isn't there a reference number or approval number that goes with it? I'm really hoping that its just a mixup and everything will go smoothly on monday.

If there is not an approval number or something similar...just make sure your doctor's office gives to you IN WRITING that the procedure is approved at your insurance levels. With that.. you should be okay.

Again... I am so proud of you for persevering even through these difficult times. This shows that are are a candidate who will really really work their band! I can't wait to hear from you post-op and learn of your weight loss success!

You go, girl!

[juliegeraci 7]

I am really glad you delayed your surgery. There was another horror story on here where the insurance company actually denied the claim and it was approved as well. I am glad you are following up. Good luck tomorrow.

[innwtitdtity 57]

How did you make out? Did your insurance cover your surgery?

[Kate228 0]

Thats guys for asking... Everything turned out fine with the insurance. They said they originally denied me but after receiving all of the paperwork they approved me. I guess they were a little delayed in sending out the first denial letter. They said I should have my approval letter next week :wink2: I have to say the surgery was rough. I'm doing better as time goes on but I wasn't expecting all the nausia and throwing up. My doc called in an anti nausia med. and its helping alot.

You guys are great, I'll keep you posted