Hospital denied my insurance

[b_co 30]

I got a devastating phone call today. I had my first consult scheduled for 4/30 and a nurse was reviewing my file. She saw that I had United Healthcare Oxford, and I was told that the hospital doesn’t accept my insurance. My heart immediately sank. I called my insurance 2 weeks ago to be sure that everything was in check, and they verified that they did cover bariatric surgeries as long as it was done in a Bariatric Center of Excellence, and this hospital is. So I’m a little confused and heartbroken that this is happening. I really don’t know where to go from here.

I have heard so many stories about how insurance has denied surgery, but never a hospital denying insurance. It’s bad enough that I have **** insurance to begin with. I’m just truly devastated...

[Ivy Joel 12]

I am so sorry! But keep trying! Keep making phone calls! There's always a shot that you could get a hold of the right person with compassion and can make things happen! Wishing you the best!

Sent from my SM-G920T using BariatricPal mobile app

[Seahawks Fan 771]

1 hour ago, b_co said:

I got a devastating phone call today. I had my first consult scheduled for 4/30 and a nurse was reviewing my file. She saw that I had United Healthcare Oxford, and I was told that the hospital doesn’t accept my insurance. My heart immediately sank. I called my insurance 2 weeks ago to be sure that everything was in check, and they verified that they did cover bariatric surgeries as long as it was done in a Bariatric Center of Excellence, and this hospital is. So I’m a little confused and heartbroken that this is happening. I really don’t know where to go from here.

I have heard so many stories about how insurance has denied surgery, but never a hospital denying insurance. It’s bad enough that I have **** insurance to begin with. I’m just truly devastated...

So your telling me in an emergency this place would bill you instead of your insurance? Sounds like some total BS to me. You may have to road trip to another hospital. You wouldn’t be the first to do so. Good luck!

Edited April 27, 2018 by Seahawks Fan

[b_co 30]

I am so sorry! But keep trying! Keep making phone calls! There's always a shot that you could get a hold of the right person with compassion and can make things happen! Wishing you the best!

Sent from my SM-G920T using BariatricPal mobile app

Thank you... I’m very disappointed. And confused. I’m going to call them back tomorrow and ask why this is. I was so excited to start my journey

[b_co 30]

So your telling me in an emergency this place would bill you instead of you insurance? Sounds like some total BS to me. You may have to road trip to another hospital. You wouldn’t be the first to do so. Good luck!

Thank you. I’m beyond frustrated. I really loved this hospital but now I’m starting to wonder why they wouldn’t accept my insurance. Insurance is insurance. It’s very odd to me. I may have to travel out of state

[Seahawks Fan 771]

3 minutes ago, b_co said:

Thank you. I’m beyond frustrated. I really loved this hospital but now I’m starting to wonder why they wouldn’t accept my insurance. Insurance is insurance. It’s very odd to me. I may have to travel out of state

Well I hope they made a mistake. That’s just ridiculous! Where are you from? There has to be another hospital close by that’s a center of excellence.

Edited April 27, 2018 by Seahawks Fan

[b_co 30]

Well I hope they made a mistake. That’s just ridiculous! Where are you from? There has to be another hospital close by that’s a center of excellence.

I really hope they did. I’m from the Poconos in PA. I think the main problem is that my insurance is based out of NJ, so many doctor’s won’t take Oxford. But they do accept UHC most of the time. My understanding is as long as a doctor accepts UHC, I’m covered; it’s still considered in-network. But I think a lot of the time the offices get hung up on the Oxford part of my insurance plan, since it’s a NJ/NY/CT based insurance company. There’s another BCoE near me but I work at that hospital and I don’t feel comfortable with my coworkers knowing I’m there as a patient.

[elforman 234]

It's possible that despite being a center of excellence, your insurance company is not contracted with that hospital. Your doctor may be contracted with the insurance company, but remember that doctors' and hospitals' contracts are directly with the insurance company, not each other.

For example, my wife is about to have a knee replacement and her orthopedic surgeon is contracted with Cigna, our insurance company. But when he submitted the authorization request, we found out that the hospital where he normally performs surgery is not contracted with Cigna and he doesn't perform surgery anywhere else, so we had to find a different surgeon and hospital.

It sucks that you find yourself in this situation, but the sooner you discover things like this, the better.

[elforman 234]

Also, regarding an emergency situation. Insurance companies will pay for emergency room visits for any hospital. However, if you go to a hospital ER that is not contracted with your insurance company and you need to be admitted, the insurance company will have you transferred to a contracted hospital ASAP unless it is too dangerous to move you.

[Frustr8 7,886]

I guess that does make sense to insurance providers, as only a providee it seems warped and weird.doesn't it?

[FluffyChix 17,415]

Jeeze! I'm sorry you're going through this. The whole insurance approval and hospital approval thing was maybe the WORST and most stressful part of the whole pre-surgery/surgery show.

Hope you get it figured out!

[b_co 30]

Hey all! Thanks for all of your support. After I had a little meltdown (haha) I got back to researching. I cancelled my appointment that was set for 4/30 and registered for another information session at another hospital in NJ who I know (for sure this time) accepts my specific insurance. And my insurance accepts them. The info session is on Thursday 5/3. The info will probably be redundant but at least I'll get a feel for what this hospital offers.

Let's hope this one works out lol

[Frustr8 7,886]

I'd cross my fingers and toes for you but it does make it difficult to walk,that way. Certainly,I do wish you well,I am one person on here who does understand your trials, I had to affiliate with a second hospital, I hope this one turns out to be just what you want and need. 🏥😝

[b_co 30]

6 hours ago, Frustr8 said:

I'd cross my fingers and toes for you but it does make it difficult to walk,that way. Certainly,I do wish you well,I am one person on here who does understand your trials, I had to affiliate with a second hospital, I hope this one turns out to be just what you want and need. 🏥😝

hahahahaha! Thank you for the laugh! It's nice knowing there are people on here that understand what I'm going through