My Journey and Fighting Insurance Issues

[FinallyLosingIt20 16]

Hi Everyone! I'm from NW Indiana, and I started my journey nearly 18 months ago! After pills, diets, exercise, etc. I finally got a referral from my family doctor to see a bariatric surgeon last July. I called my insurance company and they said my insurance was covered if I met their prerequisites. I let the surgeon know and they of course called after my first appointment and they got the list of prerequisites. Although I had spent 6 months on a supervised diet with weigh ins twice a month, I had to do 6 months with the doctor and nutritionist, maintain my weight, have a 5 year history, show previous attempts to lose weight, etc. So I did all the standard things, and it was time to submit to insurance in February of 2020. I got a call from the nurse at UHC to check on me after my procedure, but I had not yet had any procedure. Nothing was approved yet! So the nurse checked and the procedure was denied - it was excluded by my policy! I was upset and appealed. My surgeon appealed, because they had a preapproval number from September. Still, UHC refused to cover anything. I was upset, and researched it. I found a website for my state that had information about Healthcare complaints, so I filed a complaint and included information about their calls with me and the doctor's office. I suggested that they review the calls and retrain their employees to properly look at a caller's insurance, because they always say to "Call the number on the back of your card to verify benefits." Then COVID 19 closes everything. The doctor's office closed my case, and I started researching self-pay. I found Blossom Bariatrics in Las Vegas, and I paid my deposit and scheduled surgery for June. Yesterday I received a letter from UHC. They are paying for my surgery with my original surgeon. I thought it was an error, a joke, a dream?!?! I called my surgeon's office and sent them a copy of the letter. They called me in shock and asked what I am doing in July. Well, I think I'm having my Gastric Bypass and hernia repair in July now - close to home and without traveling. I'm worried something will happen to change that. I am out $550 because I paid a deposit to Blossom and for an appointment. I called today to reschedule for now - I don't want to cancel and have my other surgery fall through and be left with nothing. My surgeon's office said I am only the second person to successfully battle UHC over their error and actually win. I am worried the bill will exceed the $40,000 limit that was not a condition of the original guidelines, and I am scared they will find a reason to refuse payment. I am anxiously awaiting surgery in 6 weeks and 4 days.

[PlanetHopper 86]

Wow! You went through a lot and I want to say congratulations on fighting for your health! You didn't give up no matter what. I really, REALLY hope the surgery scheduled in July does not fall through. I think you have made a great plan by keeping the other surgeon an option just in case. I wish you the best with your surgery.

[NovaLuna 710]

Sometimes we have to jump through hoops to get the things that we want, but I'm glad that it seems to be working out for you! I know how difficult it is when insurance denies something you NEED! My own experience happened three years ago when I had to battle my own insurance to get an MRI so that I could get the visual proof that I have TN so that I could see a neurosurgeon and originally they denied it, but my neurologist at the time fought it for me and sent in four different requests before finally telling them he was checking for a tumor (TN can sometimes be caused by tumors, mine isn't). I was lucky that he was so set on getting approval because I couldn't even get a hold of anyone, but they finally did approve it and I got my proof, had my brain surgery and have been relatively pain free since (a few flairs came back last year, but are soooo much better than they were).

I hope everything continues to work out for you and congratulations on your upcoming surgery!

[PlanetHopper 86]

On 5/29/2020 at 4:18 AM, NovaLuna said:

had my brain surgery and have been relatively pain free since

wow! that's incredible. I'm so glad your doctor advocated for you and that you chronic pain has decreased