Sneaky insurance company?

[Katrinakit 139]

I am getting a bad feeling about this... I had contacted my insurance plan and they said that they covered bariatric surgery at 80% and the woman rattled off all of these criteria for me including a 6 month diet. She was talking so fast I didn't get it all though. Then the woman at my doctor's office called to get the specifics and they wouldn't tell her anything. So I called again and asked them to fax the criteria and they said they can only speak to the providers about the specifics and gave me a phone number for them to call. So she called back and they told her there wasn't really a list of criteria and they were just supposed to submit information about why I need the surgery and they would get back to her about whether they would cover it. She replied "that's not how this works. How can I play baseball if you don't first tell me the rules of the game?!" But that was all they were willing to say. She says she has never had an insurance company act like this before. I'm a little worried this is going to be a problem.

[RILEYSMOM22 344]

I don't know why they wouldn't speak to you about the specifics. You are the customer. I have Indep Health. I called and the customer service person I spoke to said they would send me out the criteria. I got it two weeks later.

[Katrinakit 139]

I know! That's what makes me nervous! Why the secrecy?

[The Candidate 3,215]

That's a shame. You have a consumer relationship with them, so there should be no reason to "hide" any information related to your policy from you. Hope things work out!

[Chele H 427]

I would call again and ask for WLS requirements in writing to be faxed, emailed or mailed via USPS. If this request is denied, ask for a manager. If your health insurance is through your employer you might be able to get your HR dept. to help.

You or your employer basically have a contract with the insurer and you are entitled to see and know what your benefits, exclusions, requirements, etc. are. Someone, somewhere has a copy of this contract. When I call my insurance company with questions, they actually access my policy on the computer screen in front of them and read me the answers to my questions.

Call again, don't give until you have answers. Good luck.

[Katrinakit 139]

I'm at a conference right now and when I get home in a week I will look into this more but my surgeons office called and told me they just want me to go through their 3 month pre op program (monthly weigh ins, psych, nut, meet with surgeon, support groups etc) that they make everyone do and then just submit to insurance and see what they say! Surely they have to say why they are denying me at that point, right? Lol

[BLERDgirl 6,417]

Don't let them get away with that. They have to by law provide you in writing what is covered and what is not. I agree, ask again and if need be speak with a manager.

[Yaberhoo 358]

Chele took the words right out of my mouth....or fingers....whatever. You were dealing with an inept or lazy representative. If you call back and get the same treatment, immediately ask for a supervisor. They have an obligation to provide you with a written list of their requirements if they are going to hold you to them. You can't meet those requirements if you don't know exactly what they are.

[Chele H 427]

I'm at a conference right now and when I get home in a week I will look into this more but my surgeons office called and told me they just want me to go through their 3 month pre op program (monthly weigh ins, psych, nut, meet with surgeon, support groups etc) that they make everyone do and then just submit to insurance and see what they say! Surely they have to say why they are denying me at that point, right? Lol

Absolutley DO NOT do this....you could be wasting your time and money.

[Katrinakit 139]

It's actually free. But don't worry I will call when I get home next week

Edited September 23, 2015 by Katrinakit

[newmebithebypass 713]

Call and ask if they have a bariatric coridinator

[Katrinakit 139]

So I called and first they told me the couldn't mail, fax, or email me but they could read me the criteria over the phone?! And then after reading jt to me she said she would "draft an authorized letter" or something and get it approved and hopefully I will get it in the mail within 10 business days after the approval so maybe in two weeks. So we shall see. So weird. It's blue cross too. It's not like they don't have bariatric patients.

[tripletmommy+2 1]

I have MHS Hip plus and I was given the run around too. They will not give me any information other than they cover bariatric surgery.

[Katrinakit 139]

I actually did finally get the letter in the mail! So now I have it in writing which makes me feel better. Any luck with your insurance, tripletmommy?