confusing letter denial or approval....

[cali girl 0]

I am new to joining but have been keeping tabs everyday on here for the last 3 months, so I went to my Dr. and explained to her taht I was interested in getting the lap band surgery. I have a friend who just got the lap band about 4 months ago and he loves it. So I told her the Dr. I was interested in using, she told me since I have HMO I will have to see one of the Dr.'s in Straubs network first then can be referred out since the dr. I am interested in is in a different network. So I go and see a nutritionist and it comes to be that this whole appt. is about seeing a surgeon for the gastric bypass surgery what i specifically said I did not want. So I had to pary the $85 for her and a $15 co pay to see the s,urgeon who does'nt even perform the surgery nor does any dr in my network...Im so frustrated, then I recieved a letter from Straub saying that the reason for the denial os because "SERVICES AVAILABLE THROUGH THE STRAUB HEALTH CENTER NETWORK" but in the letter it also says Service: Pending Authorization. So I am so lost..Please help:help:

[Alfie 58]

Hi Cali, Maybe you should call your insurance and ask them if they cover the lap band. My insurance, Aetna, didn't cover lap band for a long time but it does now.

[Talyn 0]

Cali

The letter means that your insurance company has denied the services as the are outside of your network. Most insurance companies will not cover out of network care, unless the care is not available from an inplan provider.

Hope this help

Talyn(rn, managed care nurse)