First problem, required but not covered?

[Nightshade 0]

Okay. So first thing is I have Aetna better health premier insurance out of Michigan. It is a Medicaid/Medicare dual enrollment plan that I've never had issues with before. Prior to receiving my referral to Bronson Methodist hospital two years ago I haf called my insurance and asked about covered services. I was told they'd cover everything as my BMI was over 40. After working for 7 months to complete paperwork and go to the required before initial appointment but always full seminar, the surgeon left and I had to start over at Borgess Surgical in Kalamazoo. Now I'm finally on to month 1 of my 6 medical weight loss appointments, and the surgeon requires a checklist to be completed and at least 2 nutritionist appointments. At my first appointment the office made me sign a waiver. Stating that i understood my insurance may not cover the 400 dollar group session, which doesn't count towards. my at least 2 appointments with that employee. I've since called my insurance and had to be transferred four times in order to be told that person has to make a bunch of calls and then would call me back. Has anyone else had any similar issues? How was it resolved? And does anyone have Aetna better health? Did you have any unexpected bills? Was the approval process difficult? Thank you.

[Ms. Brightside 121]

Do you have a deductible you must meet? If so, perhaps your insurance company will apply the cost of the group session to your deductible, since it is a requirement for surgery. It doesn't hurt to ask!

[Navigating the Wilderness 824]

I don't have the same health insurance, but I can say during my lap-band the Dr.'s office charged me for the following, none of which insurance covered:

$80 per visit to their NUT, x6 monthly visits.

$200 for a visit to their Psych who had promptly handed me a piece of paper stating her fee was normally $500/hr but she was giving me a 'discount'.

$500 to cover the cost of future group sessions.

When I wen to the latest Dr. for my sleeve, the only thing I had to pay for besides co-pays was my psych eval.

I do recall at the first place where I had my lap-band done there was a lady in the waiting room with me that was very upset because she could not afford the $500 fee and the surgeon would not perform the surgery without the payment up front. I thought that was really, really shitty of them.

[Ms. Brightside 121]

4 minutes ago, Navigating the Wilderness said:

I don't have the same health insurance, but I can say during my lap-band the Dr.'s office charged me for the following, none of which insurance covered:

$80 per visit to their NUT, x6 monthly visits.

$200 for a visit to their Psych who had promptly handed me a piece of paper stating her fee was normally $500/hr but she was giving me a 'discount'.

$500 to cover the cost of future group sessions.

That is insane! If it was a requirement by your insurance company, those costs should have at least been applied towards your deductible and/or your annual out-of-pocket limit.

4 minutes ago, Navigating the Wilderness said:

I do recall at the first place where I had my lap-band done there was a lady in the waiting room with me that was very upset because she could not afford the $500 fee and the surgeon would not perform the surgery without the payment up front. I thought that was really, really shitty of them.

It is commonplace for service providers to collect up front any outstanding deductible amount due prior to scheduling a procedure, as long as it is not an emergency. I have a $1500 annual deductible and will have to pay any outstanding balance on that deductible before my surgery will be scheduled. After the procedure, I will be billed for the co-insurance amount (I am responsible for 20% of all charges up to my annual out-of-pocket limit).

Yay, insurance!

[nomorefattypatty 329]

Okay. So first thing is I have Aetna better health premier insurance out of Michigan. It is a Medicaid/Medicare dual enrollment plan that I've never had issues with before. Prior to receiving my referral to Bronson Methodist hospital two years ago I haf called my insurance and asked about covered services. I was told they'd cover everything as my BMI was over 40. After working for 7 months to complete paperwork and go to the required before initial appointment but always full seminar, the surgeon left and I had to start over at Borgess Surgical in Kalamazoo. Now I'm finally on to month 1 of my 6 medical weight loss appointments, and the surgeon requires a checklist to be completed and at least 2 nutritionist appointments. At my first appointment the office made me sign a waiver. Stating that i understood my insurance may not cover the 400 dollar group session, which doesn't count towards. my at least 2 appointments with that employee. I've since called my insurance and had to be transferred four times in order to be told that person has to make a bunch of calls and then would call me back. Has anyone else had any similar issues? How was it resolved? And does anyone have Aetna better health? Did you have any unexpected bills? Was the approval process difficult? Thank you.

I also have Aetna Better Health Medicaid because I'm on SSI because of bipolar issues and I would say to call and ask who your case manager is and speak to them only this way you have one person responsible for getting you approved. I only had to pay 30.00 for my first initial nutrition class and after that my next five classes were only 15.00 my paperwork went to the insurance on the 18th of April. I have called them but I have not received a call back yet but I'm determined to harass them if I have to, all my tests, appointments, and doctor approvals are all in order and perfect so I expect them to take this as serious as I do and do their job. They've been really good so far and I've had an in depth conversation with my caseworker and I feel they are pretty well aware of what I expect. I'll keep you posted.

Sent from my SM-G360P using BariatricPal mobile app

[Nightshade 0]

I did contact my case manager, but honestly, she doesn't seem to know what she's doing. I've had issues with her since she started. But she says they are filing for prior authorization and that she thinks it should go through. Thank you for the verification that i was doing the right thing. It's taken so long just to get to this point I'd rather not have any other issues. Good luck with yours, i hope everything goes through smoothly.

Sent from my LGLS775 using BariatricPal mobile app

[Nightshade 0]

Do you have a deductible you must meet? If so, perhaps your insurance company will apply the cost of the group session to your deductible, since it is a requirement for surgery. It doesn't hurt to ask!

No deductibles, card even says "Paitent cannot be billed" right on it.

Sent from my LGLS775 using BariatricPal mobile app

[Ms. Brightside 121]

22 minutes ago, Nightshade said:

No deductibles, card even says "Paitent cannot be billed" right on it.

Sent from my LGLS775 using BariatricPal mobile app

Call, call, call and escalate, escalate, escalate, until you have answers. This just doesn't make a whole lot of sense. So sorry you are dealing with this!

[Sosewsue61 3,185]

Is there an online portal you can log into? I find it helps to address some of this in writing through the insurance communication email tool. I don't have your insurance, but I do know medicaid in Illinous will not pay the NUT and you must pay the $385 up front for the 6 visits.