Approved / Exclusion on insurance WLS

[Sugarnspice 150]

I was approved by my insurance in October for VSG. I completed all the requirement's & this week went for pre-op testing, date all ready for dec 1st. Yesterday my surgeon call's to say the hospital submitted to the benefits office who state I have an exclusion under my employer Cigna plan. I then go ahead & call my HR who puts me over to advocate who calls the insurance ( Cigna) we are advised it is covered & they will resend the approval. I just don't know what to think ?? It seems there is an exclusion but they miss it ? Override it ? I don't even know exhausted at this point with this mess.

Sent from my iPhone using the BariatricPal App

[The New Kel 1,312]

I'm sorry you are dealing with tricky insurance. I used to work in the insurance field, trying to get authorizations for medical procedures and treatments. It was a real eye opener. I learned that the smaller and more micro-managed insurance groups can basically write in any damn exclusion that want. It's awful and makes you realize that its all about money.

Even a denial can be appealed though. And even a denial of the appeal can be appealed again! Sometimes with some insurance groups you have to go through several hoops. Which is unfortunate because all you're trying to do is get healthy, which will ultimately save them $ in the long run.

Sigh....insurance stinks. Hang in there and if need be appeal, appeal, appeal!!

Edited November 4, 2016 by The New Kel

[Sugarnspice 150]

Thank you ! I will. I just keep hearing you can't appeal if it is a plan exclusion. I just don't understand why approve it then deny then approve & now I'm in limbo.

Sent from my iPhone using the BariatricPal App

Edited November 4, 2016 by lvfavy