jenjackson

I am wondering how you approached the surgery with your family dr. Did you talk to him first to see if he would do blood work and checkups after surgery? Were your Dr's supportive? I know my insurance will not cover anything having to do with bariatric surgery so do things need to be coded a certain way? Thanks for any advice!

That's good! I have gotten a few strange looks when people find out I am going to tijuana but I try to reassure them that I have done a lot of research and know others who have gone. That usually keeps them from giving me the laundry list of risks. LOL!

What do you plan on doing for follow up bloodwork? Checking levels and things?

I have no idea why I was so nervous! He was wonderful! Very supportive, willing to handle all follow up care and easy to chat with about going out of the country. Whew!!!! I feel so much better already!!

Thank you for that advice. I really needed to hear that!!

I made my appointment today to go in and speak with him about my plans. I am strangely nervous. I feel like I am going to be judged even though I know he isn't that type of person.

I have been going through the process for the VSG since April. The first step was getting insurance coverage information. When my dr office talked to the insurance company they were told that my insurance company would cover the surgery and gave them the requirements. I have since had multiple visits with my surgeon, nutritionist, classes, EGD, 2 psych consults and sleep study. I have a CPAP machine now as well. I decided to give my insurance company a call since we were still waiting for the approval, just to check the status. I was informed this afternoon that my surgeon was given wrong information and that surgery is not covered under any circumstance and not for any reason. I was completely flabbergasted. I missed work, had one hour drive time each way for all of my visits, I owe hundreds in co-pays for everything, etc. The manager I spoke to said that she is going to pull the phone conversation to see what was said to my dr office during the initial call, but I am very nervous that it doesn't matter and they won't make an exception. She did say that sometimes they will make exceptions when mistakes are made but I am so worried they won't. I have worked so hard and been in the process for so long and now I just feel completely defeated. I have no idea what to do. They said they would call me back on Thursday to let me know what they found out. I am going to be praying A LOT until that phone call comes. Has anyone ever experienced this??? Jen

I feel like I am in the middle of a nightmare! So, I finally got ahold of the lady who called me and we discussed the claims that were filed up to this point. She asked if I wanted those claims to be paid and I told her that I wanted the surgery covered that they told me was a covered benefit. She told me that she didn't think that would happen because the mistake was caught before the procedure. She put it to the claims exception committee and before the day was over I received a phone call back telling me that not only was the procedure not covered, but they were also not covering any of the copays or out of pocket costs from all of the pre-op work I had done. Even though I would have never had those medical expenses if I hadn't been pre-approved for the surgery, they didn't care. They said the claims were paid according to my coverage and I am stuck with hundreds of dollars of out of pocket costs. I told her I wanted to know what to do next and she told me that I could appeal it so I am going through that route now and I have also contacted an insurance attorney to see what my options are. I want to cry.

Well, I got a voice mail on Friday that said there was definitely a mistake made by them and now they need some information to make an exception. This is good news! The bad news seems to be that she said she didn't see any pre-op claims. Not sure how that can be....I have done a sleep study, psych visits, surgeon visits, endoscopy and obtained a cpap machine. Hopefully she will answer my calls tomorrow. She did not answer at all Friday afternoon .

I am still dealing with the insurance company. They are still telling me they are waiting on the original phone call to be pulled that had the conversation with my surgeon's office. I gave a follow up call on Friday after 2 weeks of waiting for a return call. Again I was told they would be looking into it. Getting tired of the run around! Thank you for checking in on me!

So the saga continues. I got a call from my surgeon's office and the mistake was 100% on the insurance company's part. My surgeon's office got a confirmation number and everything. Well, it turns out that the insurance company basically told the surgeon's office "too bad". They admitted the mistake but don't want to make it right. So I called the insurance company and the rep said I was supposed to have a call from a manager by the end of the day. I am still waiting on the phone call. Anthem needs to make this right. I am hoping that they do something to fix the mistake without me having to take further measures. I don't want to have a fight on my hands, but now that the fight has begun, I am determined not to lose.

So I got up this morning with a new sense of determination. I talked to my mom for a long time on the phone about it and she gave me some suggestions as well. I called my surgeon's office this morning and talked to the girl who does the insurance confirmations and she was completely shocked that they would tell me this information. She said that she always gets confirmation numbers from the insurance companies when she gets the approvals. She took my number and is looking into the issue and is going to be giving me a call back today hopefully. Tomorrow at the latest. I have decided that I am not letting this go. I have worked too hard and gone through too much to have it denied now. If they don't give me the approval I am going to make enough noise that they will have to do something. My mom suggested contacting the news about the crooked insurance system and if it comes to that, I will. After reading some threads on this forum though, I think that if I stand my ground they will fix the mistake and make the approval. Thank you so much for the words of support and the suggestions. It really helped me process everything last night after that horrible phone call!!

Thanks ladies. I did my own research before I called the dr office to get the ball rolling and I didn't see any exceptions to the surgery being covered. So, when the dr also said it was covered, I didn't think another thing about it. We pay part of our premium through my husband's employer, but not 100% self pay to them. All that I know is that they will definitely have a fight with me because I am not going to be giving up easily. I am going to fight for my ability to have the surgery and for my health. It is all just so wrong.....