Insurance Pain In The Neck

[Amanda 3.0 140]

I just want to share my frustration with the processing of my insurance claims following my vsg surgery.

First of all, I have jumped through all the hoops required of insurance:

40+ BMI to start

Documented weight loss attempts

5% weight loss during 6 month pre-op

Nutritionist appointments

Psychiatric appointments

Diet doctor appointments

Blood tests to prove I am a non-smoker

Received a letter of medical necessity approving the surgeon and hospital prior to scheduling the surgery.

To my knowledge, I am the first one to have this surgery covered by my husband's insurance. Bariatric surgery is newly covered, but not "treatment for obesity".

They have initially DENIED every claim with a diagnosis code of 278.01 (morbid obesity).

This includes the surgeon, the surgeon's pre-op visit, the pre-op blood work, EKG, etc., blood work in the hospital, etc. I have had to call and contest the denial of every claim, and each has ended up being paid. Yet it is tedious and stressful when I see these huge bills not paid. It has become a morning routine to check my insurance claims online and see for what they have denied payment. Then I make calls to a clueless person who offers incorrect explanations about my insurance coverage. I feel like I am starting from scratch every time I call.

I am now requesting review of the pre-surgical dietician's appointments which were denied because they were "obesity treatment". That was about $250 out of my pocket if I remember. That was denied as obesity treatment, when in fact the sessions were required by the insurance and covered life after surgery: Protein, meal portions, Vitamin requirements, medication management.

I guess I just feel like griping to people who might just understand. And also, I encourage people going through this to challenge anything not paid. For some insurance providers, this is new territory. That doesn't mean we should have to pay for it. We need to fight for our benefits!

[BenisaMartim4 369]

What insurance do you have? My husband works for Toyota and we have Anthem BCBS and I have had fits trying to get everything together through them too.

[Amanda 3.0 140]

My husband's company is self-insured. They use a company that administrates the benefits, and that is where the problems seems to lie.

The network is Aetna, but the employer makes the rules and requirements.

The benefits administrator is tasked with following the rules outlined by the employer. It is a bit more complicated, although most huge companies these days are self-insured (to my understanding).

We have paid for the most expensive insurance plan for years. We shouldn't be dickering about these bills.

I finally requested the intervention of a supervisor because I am tired of calling to dispute every bill. The supervisor said she will review my claims each day to ensure that my claims are not routinely denied.

All this in spite of a pre-approval letter! Not making this up.

[mommy794 119]

I have Anthem BCBS as my secondary and they approved me in like 2.5 weeks, I also have BCBS edge for my primary and they have pretty much exactly the same pre-requisites as far as getting approved. I'm sure that helped speed it along since I was already approved by my primary ins. This whole process started June 28th so it's taken awhile with the monthy weigh ins and nut and nurse visits but will be SOOO worth it, I'm sch. for 2-6.

[Tif 2.0 141]

Most insurances don't cover the nutritionist and pysch eval, which is wrong if they require it. I have BCBS of Texas through my husband's employer and I haven't had any problems with them paying except for the nutritionist. The Psych eval I just paid the $50 on my own and didn't bother with it at all.

I have to say BCBS-Tx has been really easy to work with. My employers insurance is alot tougher and it's because my employer is self insured. It's a night and day difference.

[bjstrans4mation 21]

I am grateful!! My insurance is Aetna and they covered everything. My only responsibility was co-pays. Blessings2u--BJ

[Ms skinniness 3,003]

I have Kaiser and live in orange county and was given a referral to a bariatric surgeon. I kept getting bills stating the claims were denied and I totally freaked out. I couldn't afford to pay for the surgery, it had been preapproved. I called Kaiser's billing department and they said don't worry about it, the bariatric hospital was sending them incorrect statements. They did eventually pay for the claims. THANKFUL, it was a hugh amount of $$$$$$. It is frustrating!