Insurance Reimberments???

[eljmom 1]

Has anyone ever been reimbursed by insurance after getting the surgery and having to pay for it on your own? I am just curious. I just found out that I have to pay out of pocket for a 6 mos medical assisted diet, in order for insurance to cover the surgery. It's a catch 22. They wont pay for surgery to solve the weight and health issues up front, and they wont pay for a medical assisted diet either. What up with that?

Any ideas??

[Alexandra 55]

The six-month medically supervised diet doesn't have to be anything more elaborate than visiting your PCP every other week or so for a weigh-in. Why wouldn't your carrier pay for those visits? Do they have an exclusion for all weight-related treatment?

[conniesueb 1]

I had to pay for my surgery up front, and am now waiting to be reimbursed. I sent in for pre-authorization before my surgery though, so I would know if they would cover it or not, and they said they would, but trying to get paid back has been a nightmare! I had three different claims to send in--one for the surgeon, one for the surgery center, and one for the anesthesiologist. The first one, for the surgeon, was $4000.00. When they processed it, they processed it as an in-network claim, and only allowed $1072.00, and they sent the check to the surgeon instead of me. The office manager called the insurance, and explained that he has two differnet tax ID numbers--onw for all his other surgeries, which he is in-network, and a seperate one for lapband surgery, which he is not in network. They told her to send the check back, and they would start over and re-process it with the right tax ID number, and send the check to me. Well, they did send the check to me, but they still used the wrong tax ID number! They are not even paying attention to what is on the receipt I sent with my claim! So, I had to send it back AGAIN and am waiting for them to try a third time to process it right! The claim for the surgery center was $7800.00. They requested surgical notes, and said they needed the surgery center's tax ID number before they could process that claim. When I called the surgery center to get the tax Id number THEY WOULDN"T GIVE IT TO ME! They said the insurance shouldn't need it since I was self pay! I told them that they couldn't process my claim without it, and she still wouldn't give it to me. She said another patient with the same insurance was denied and they had to refund her money, so now they won't give out that info, because they are afraid the same thing will happen! I told her that even if they do deny it, it is between me and my insurance company because they had already been paid. She still wouldn't give it to me, so I called my surgeon's office and thankfully, they gave it to me. So, I faxed the info to ins. co. and called last week to check on it, and was told that the info was never received. Someone gave me the wrong fax number! I am so frustrated at this point, I could just scream! So, I had to re-fax it, and I mailed a copy just to be safe. Then the check for the anesthesiologist was sent to him and not me too! I wrote in big black letters on the claim DO NOT SEND CHECK TO PROVIDER--SEND TO SUBSCRIBER! They just don't pay attention to anything! So, I called the anesthesiologist's office and begged them not to send the check back to the ins. Now I am waiting to get a check from them, because they could not just sign it over to me for some reason. So, My surgery was in November, and I have not gotten a dime back yet! So, moral of the story--insurance companies are a big pain in the butt!!!!! Be careful!

[eljmom 1]

I will have to see how we can get around it. They will pay for High Blood Pressure issues, so I guess we can note it as that. Now that I know this is an issue and I can do something about it for LIFE, I just want this to start now. Patience was never my best quality. My job is in the low season now, it starts back up in September. I was hopeful that this would be done and I would be recouped before the stress of my job in its busy season starts back up. This is when my Blood Pressure goes up the most. Not to mention the feeling of 'ALWAYs' hungry.

My Lap Band Dr. said, that even if I start losing the weight through the 6 month weight, my original weight would be the deciding factor for insurance, not the new weight. I am on the cusp of the BMI number, so I dont want to rock the boat, if it will hurt me in 6 months. Just can't imagine not trying to start getting the head and body ready for this important life changing situation. Will I hurt my chances?

[marlynncreel 1]

what they're hoping is that you will view as too big a pain in the rear to pursue and just drop it or be too stupid to realize how to handle them, becoming too confused and agitated to finish the ordeal.

[Big As Life 0]

My insurance company just out and out refused to pay for anything that has to do with obesity....Makes me so mad....but...I decided to self-pay and so glad I did....It is going to being so worth it...it already is...

[isabelle290 0]

Get this- I went through the 6 mo. med. suppervised diet and they STILL denied me! Cigna does not want to pay for this surgery and they do everything they can to get out of it. I am fed up and am going to Mexico. It makes no sense, especially with all the reports out there about obesity in America. You would think the government would do something to stop these insurance companies for taking our money and not covering us in our time of need! I guess I am doing what they want though-giving up and going somewhere else.