Oh no.....

I am 3 weeks POST op and NOW the insurance is saying I didn't have the required 6 months supervised diet.

My surgeon's office handled ALL the insurance paperwork and I didn't even find out until the day prior to surgery that I was "good to go" as they put it. I had called the surgeon's office to find out if they had heard anything from the packet they had faxed to the insurance company a week before. The insurance coordinator said they had not heard yet, but she would give them a call and get back to me later in the day. She called a couple hours later to say I was "good to go" and that I didn't need anything else.

I see where the hospital has submitted a claim of $18,000+ and the surgeon has submitted for a bit over $10,000. I can't afford to self-pay that kind of money. If I had not been approved, I MIGHT have tried for a loan to have it done in Mexico, but not THIS kind of money!!!

I even ASKED the coordinator at one point about a 6 month diet because so many people on these boards had to do that. (I thought since I had several co-morbidities...diabetes, high BP, and a couple more I might be spared......)

Now what??????

I believe I would have to pay them $1.00 a week!

See what you can find out about how the surgeons office was given the "go ahead." If they received a letter or something documented, you might have more ground to stand on.

Oh my gosh. I would be so mad. You would think that everything would have been taken care of if she told you that you were "good to go." This is a major cost.

I would find out from the coordinator why they stated I was "good to go" when I needed the 6mo diet. If the insurance company has approved the surgery without the 6mo diet, then by the majority of the state laws say they cannot take back what they have already approved.

I would think that an approval is an approval. I would not think there would be a court in the land that would allow them to deny now.

If it is somehow denied, my thoughts fall with Dana......$1.00 per week....and tell them to take it up with the insurance company since their insurance coordinator told you that you were "good to go".

Of course, I am in a rather negative mood today so I may have a nicer reply tomorrow....or later today.

Either way, this is not your fault and you should not have to pay. I guess that would be my nicer remark. :cry_smile:

I would think that you should have been in contact with your insurance company directly. My surgeon's office coordinator is handling my paperwork, but I have been in contact with my insurance to verify all the requirements beforehand to ensure that I met all of their qualifications.

When/if my surgery is approved (paperwork was just submitted yesterday for approval), I will be checking with my insurance company directly to verify this information and get some form of documentation of their approval before proceeding with the procedure. It's always good to have all of your documentation in hand so you have a leg to stand on if anything like this should happen. I have copies of everything I've done so far and will continue to collect and keep the documentation until well after my procedure is done.

Good luck to you, I hope everything works out for you. I agree that you should ask the coordinator that handled your paperwork and told you that you had the go ahead to provide some documentation of how she received the approval!

Blessings,

Nat

If your providers (doctor & hospital) are considered in-network for your insurance, their contract with the insurance company may require that they be obtain the necessary precertifications before surgery.

Memaw Have you heard anythign New from the Dr's office this is terrible... I wonder about these things ever day!!! My Surgery is scheduled for the 18th and I'm waiting for them to say oh it didn't go through.

Alot of Hospitals charge extra if they know you have insurance. If you decide just to pay the $1 a month @ least try to get the total amount due lowered. For example when my Significant Other went into the emergency for metal in his eye the hospital had just used his prior account information. But this time when he went into the emergency room he didn't have insurance anymore. He called and told them that & they told him his bill would be lower because he didn't have insurance. And it was. I still have to agree with the others---you were given the go ahead, and you had co-morbities. It sounds like they get to eat their mistake.

Whenever I deal with something similar...I always document it with the name of the person I talk with the title and write down everything they say and tell them I am doing it. I hope you did that.

I hope they have written documentation at the hospital on this. Good luck I would be so po'd I would be spitting bullets by now.