Please Help Lap Band Surgery Canceled

[jess0504 1]

Please give me some feedback of what to do. My surgery was supposed to be in 14 days and I haven't heard from my doctors office about insurance aprroval. I called the docs office and they asked me to call my insurance to find out what's going on. I called the insurance to find out baratric surgery is not covered at all. To make a long story short I called the docs office back and they said they verified that indeed they do cover the surgery because they called and asked in september. I then called back the insurance company and they referred back to septembers notes and showed they called only to see if a upper gi is covered. I did so much to get this surgery 6 months weigh ins, cardiologist, endriocolgist, polmongist, Gail bladder sono, upper gi, and physic evaluation. And they canceled the surgery in 1 sec. I feel like someone is responsible for this. What do I do???

[heidib 15]

it's not covered even if you have serious health issues? I dont know what you can do if they say its not covered. maybe sombody else can give u better advise. I'm sorry for you what a let down, good luck!

[heidib 15]

sounds like doctors office screwed u there by not asking right questions. then you got ur hopes up went through all this testing to find out now you cant get banded.well insurance has the notes maybe u can see who called and raise hell! i dont know if they can do anything though. I"D BE PISSED!!!

[jess0504 1]

Nope it's not covered no matter what. It's a blame game at this point the insurance says its the docs fault and the docs office are saying its thier fault. According to the insurance company the office never even asked if the insurance was covered. The docs office says they are the innocent third party, I don't agree. I think they dropped the ball big time, and they don't even care. Should I get a lawyer??

[jess0504 1]

It was so close I could taste it. 7 months of pre op for no reason I am in such shock

[heidib 15]

Yeah they all love to pass the buck....i hate that!!! It is up to you weather you want to get a lawyer or not. I would say they really played with your emotions thats for sure!!! JERKS! your right they dont care.

[Quinnmc79 27]

So sorry for your situation. What a heartbreak! Unfortunately, a lawyer won't help in this cases, since that info is readily available to you as an insured. You could have called to check if your plan covered WLS.

Unfortunately there is nothing you can do to either doctor or insurance company. Can you self pay or finance?

The sucky thing is there are quite a few companies that opt,out of covering WLS of any kind in their employee health care regardless of comorbidities and health issues. If your company opts out, than there is nothing any insurance carrier or doctor can do to help you get coverage.

[Cocoabean 430]

I don't know...seems like there was a bit of fraud. One of the first things my surgeon's office did was verify my coverage. Someone profitted from you having all those tests done when you didn't need them (or at least you would not have had them if you had not been prepping for surgery). You are out several co-pays. All the time off work you may have taken for the appts. Your insurance company is out for several office visits with the surgeon and specialists you saw.

Quinnmc is right, though, the info is available to the insured as well as the surgeon. Before I did anything I checked my coverage.

You might wander over to obesitylaw.com and see what they say.

[#MagicWithinme 173]

I don't know...seems like there was a bit of fraud. One of the first things my surgeon's office did was verify my coverage. Someone profitted from you having all those tests done when you didn't need them (or at least you would not have had them if you had not been prepping for surgery). You are out several co-pays. All the time off work you may have taken for the appts. Your insurance company is out for several office visits with the surgeon and specialists you saw.

Quinnmc is right, though, the info is available to the insured as well as the surgeon. Before I did anything I checked my coverage.

You might wander over to obesitylaw.com and see what they say.

I agree, there were several tests and (still coming in) bills that say I am responsible because insurance does not cover testing or follow up for this kind of diagnosis. I'm still waiting to hear from insurance. The drs office said some insurances allow $15,000 for this type of surgery and more and its out of pocket, but I have spoken to 2 co-workers who have had both the gastric and lapband and they have no problems with insurance. Right now I feel had I known all this there would have been a good chance I wouldnt have done it.

[jess0504 1]

Thanks for all the input. I didn't even think about checking with my insurance company 1st because since day 1 all I heard from the docs office is "we will take care of everything" that is my fault also! Thank you For the website I was look around see what I find! The fight for lap band isn't over yet!

[kath133n 1]

This is a tough situation and I truly feel for you. I was originally supposed to have the surgery in november and 5 days before surgery my insurance company denied it. Turns out the doctors office forgot to send in some paperwork and it was later on approved for January. What I'm saying is it is completely possible for a doctors office to mess up, but at this point it's highly unlikely. Most surgeons have a general list of insurance that covers the surgery so they would have informed you up front if your insurance company was not one of them. I would really fight for this one - I had to, and won. Do your own research on the insurance see if it's really not covered or if they are giving you the run around. If its not - the problem lies within the doctors office. Good luck!!!

Kathleen

[jess0504 1]

Totally agree with you Bert I wouldnt even gone through all this if I knew at the end of the day it wouldnt have worked out

[AmyD102 95]

Thats horrible! My sureons office made me call my insurance company (BCBS of MA) to ask them 3 specific questions before i even met with the surgeon. 1) is weight loss surgery covered under my plan 2) are there any employer exclusions for this type of surgery and 3) If there are going to be any additonal amounts/payments due for a hospital stay (one night stay). It turns out that the doctors office had a few situations were people insurances denied because there employer had a weight loss exclusion on there plan (would never cover it for any reason) and other people had additional $1000 costs for the hospital stay (that they were very upset about) so now they make every patient call and ask those questions before you can schedule anything! Smart on there part! It would be nice if they all did this so these type of situations would be avoided , I hope everything works out for you

[NWgirl 574]

I had this happen to me last year. I am still insured under my parents, and so last year I went to Oregon Weight Loss Center and they said the same thing (they would check on insurance, no need to worry, bla blah). I received a letter in the mail from OWLS outlining my benefits.

Being worried it was too good to be true, I decided to call insurance and verify again. I was then told it was not covered. In the end, the customer service rep who I called did a three way call with me to the insurance coordinator at OWLS. Turns out she just assumed because of my insurance plan (my stepdad is employed at BCBS and they offer three separate plans, only one of which covers bariatrics) that it was the plan that covered WLS, but did not bother verifying. There was no apology on her side.

I am now insured under my step-mom's Kroger insurance, which covers bariatrics. Needless to say, I decided to go with another clinic that OWLS.

[shues138 35]

Also, I would call the insurance company to see if WLS surgery was excluded for this year and not last year. You said that the mds office called in September to verify coverage. If they provided CPT codes and ICD-9 codes, they would have advised right then and there that bariatric surgery would not be covered. That could be a possibility that they would pay for it in 2011 and not 2012. Also, the doctor's are usually good about this because if it gets denied the MD doesn't get paid and they don't like that.

The same thing happened to me, it happened to be the insurance companies fault. They kept saying the sx would be covered and when the authorization was submitted it was denied for a contract exclusion. I had to pay out of pocket. Hang in there, insurance companies suck, I work with them every darn day.