jillh1981

United Healthcare Options PPO through UMR.

All I have is a letter stating they found me to medically in need of the surgery, and that the letter is "not a guarantee of payment". That's all I ever rec'd from my ins co throughout this entire process (until, of course, it was over and they started sending me 'explanation of benefits' stuff). I (stupidly) assumed it was the surgeons' office job to get all this worked out, as they assured me they did. I was even told that they couldn't do surgery without ins approval. PS - I'm assuming lawyers don't handle this kind of stuff for free, right? :-/

You're right - my "approval"/medical necessity letter does state that this does not guarantee payment. If that was the case though, why did they pay everybody, only to now frantically demand it back?! That makes absolutely no sense to me. Or, better yet, how about they alerted me of this BEFORE my surgery?! Also, if these are the rules, and they can change their mind at any moment, then why do they EVER pay for ANYTHING for ANYBODY?! I can't wrap my head around this. I really thought MY insurance company that I've been paying for four years would be on MY side.

Honestly, that was my first thought. But who would be sued in this instance? The Ins co or the Doc?? And, in the end I'm afraid it would turn into one of those "you should've known your own coverage!!"

I rec'd a letter in Feb from the insurance company stating the surgery was a medical necessity. The surgeons office says they don't proceed without approval, so they aren't sure what's going on. What's weird is my ins. co has already paid everybody, but now they are taking it back. I didn't even know that was possible.

Hello everyone, I started my sleeve journey in August, when I was told my insurance company required 6 months of work with a dietician, as I'm sure a lot of people here have experienced or heard of. I did all that, jumped through all the hoops, and was sleeved March 7th. Fast forward almost two months, I just yesterday found out my insurance company does not cover the sleeve (??????) and I've now acquired $65K in surgery bills. I called the insurance company and the man I spoke to said they only cover diagnostic fees that come with it (whatever that means) and that was the end of that. I called the surgeons office in tears, and they said they'd never heard of anything like this, but that they got their money so the letters I received from my INS company must be "erroneous". After speaking with them today, they told me that even though the insurance company had reimbursed them, they just found out today that they are asking for the money back, and that they are going to appeal it. WHAT DOES THIS MEAN?! Has anyone ever had any problems of this nature? I went from only owing $2500 in deductables to $65,000!! I could've gone to Mexico and had a sleeve vacation for $10K! I am so beyond upset right now, and feel like my insurance company is trying to ruin my life. Please, any advice/stories/knowledge would be greatly appreciated.

I went to the ER yesterday and they did a leak test (via cat scan, I drank some clear fluid that tasted like stale, slightly fruity water) and also a cat scan for blood clots with the dye, etc. There were no leaks, and thye fluid around my spleen had lessened since last week. The scan for the blood clot didn't take as well as theyd like so they did ultrasounds on my legs and everything was fine. I was sent home after 7 hours of waiting and told to just take pain meds, which was a little relieving and frustrating at the same time. Needless to say, I didnt take pain meds. I really don't like pills. Anyway, today my new pain involves chest pain that comes on without any notice (the pain yesterday was when I would inhale). This feels like its my sternum or esophagus and it just shoots right up and I have to clutch my chest. My boyf keeps telling me to just take my pain meds but I feel like that could numb whatever warning signs I might be getting about my body. Also, I would feel almost foolish going back to the er at this point. Anyone else dealt with chest pain?

Hi all, I am a new member. I'm writing this on a tablet so please disregard all the typos :-) . I had my sleeve surgery on march 7th, and have been nothing but unhappy and depressed about the whole thing since. I didn't gphave problems until I came home, and mostly it was that mtpy pain meds (liquid vicodin) were so gross that I couldn't keep up with it and found myself dehydrated and in a lot of pain, which sent me to the ER. They did a an xray to see if it was gas, then a cat scan and said I had some Fluid around my spleen, but that it was probably drainage from surgery. (I asked them if it could be leakage and they said no, I would be very ill. He also phone my surgeon and she too confirmed this). This was Sunday following surgery. I was sent home with zophran (anti nausea) and liquid T3, also pill form Vicodin, which I have been taking and doing well on. Basicalling, I've been doing better until last night, when I started having a lot of pain in my lower back/kidney region when I inhaled. I am trying to ween myself off pain meds so I can go back to work so the day before yesterday I had none, and when I took a half of Vicodin lasrpt night, it did nothing to touch the pain. I literally had to grab my back and squeeze to offset the pain to get a good breath in. I went to bed and it was easier to breathe, but still painful. I woke up today and now it is in the front as well as the back and I wanted to know if anyone else has dealt with this. I really don't want to go to the ER again, and I just want to feel well/normal again. I spent most days after surgery crying and wondering why on earth I did this to my body, and I'm feeling so hopeless. Any help would be greatly appreciated.