Insurance says "yes" and after surgery "no"

[Fran 1]

Please, I usually do not rant and rave but I am besides myself with worry. The surgeons office had called and told me I was approved for a TT and I had it done March 26th. Now I get a letter from my insurance carrier (GHI) which says they do NOT pay for plastice surgery. I am besides myself with worry over this, and hope at least the hospitalization is covered but how can it be if the surgery is being denied. HELP!!

Be well.

Frantic Fran

[coltonwade 27]

Please, I usually do not rant and rave but I am besides myself with worry. The surgeons office had called and told me I was approved for a TT and I had it done March 26th. Now I get a letter from my insurance carrier (GHI) which says they do NOT pay for plastice surgery. I am besides myself with worry over this, and hope at least the hospitalization is covered but how can it be if the surgery is being denied. HELP!!

Be well.

Frantic Fran

Have you called the doctors office ?

Sometimes its a screw up where something was not turned in properly and once the paper work was done correctly its fine.

I would call the docs office first .

HTH

good luck

Mindy

[Fran 1]

I got the letter on Sat. and have to wait until tomorrow (Monday) to call. I hope and pray that some person mixed up a code or something like that. Perhaps it should have said reconstructive surgery and not plastic. Will let all know what happens. Thank you and be well.

[StephC 0]

Your in my prayers Fran - and now you got me scared! :smile2:

[Lap_dancer 8]

Typically they need an authorization NUMBER to proceed with surgery. Sounds like a glitch. After having the plastic you know that you have already gone the great distance of weight loss. Power and strength is on your side. This is but a pebble in the lake.

[coltonwade 27]

My guess is it is a mix up, I have heard of people being denied BEFORE surgery but not after the surgery was done. I think my response would be "TOUGH SH*T !! You should not have authorized it im not paying you back a dime " !

Good luck let us know

Mindy

[Marimaru 7]

I think I've heard of things like this before and the thing I always see is that you should wait to get the letter from your insurance regarding whether the procedure was approved and not trust what the doctors office says for reasons like this.

I hope the doctors office gives you good news today!

[Daisalana 33]

I have had this happen before, and it ended up they put my wrong insurance card # in after the fact. Don't panic yet, I ended up calling the hospital's billing and they fixed it.

[StephC 0]

Fran keep us posted.

[Fran 1]

Let me tell you how right you are. Tough sh-t is mild in comparison to what they can do. I am just worried that the hospital stay will not be covered and that can add up to $$$$$$$$$$$$$$$$$$$$$$$.

Will keep all posted. Thanks and be well.

Fran

[Fran 1]

It is not the insurance number, but the type of surgery. I spoke to the woman in the doctors office today, and she said that she was told it was authorized. Let her fight it out with them. I would never have gone ahead with this now if I was self pay as I have a son who is recently home from rehab and he has cost me a fortune. I hope the hospital stay does not get rejected. If the hospital stay gets paid, then I had a true TT (Tough Titties) to whomever made the mistake.

Be well.

Fran

[coltonwade 27]

It is not the insurance number, but the type of surgery. I spoke to the woman in the doctors office today, and she said that she was told it was authorized. Let her fight it out with them. I would never have gone ahead with this now if I was self pay as I have a son who is recently home from rehab and he has cost me a fortune. I hope the hospital stay does not get rejected. If the hospital stay gets paid, then I had a true TT (Tough Titties) to whomever made the mistake.

Be well.

Fran

Did anyone get ANYTHING from the insurance company before surgery saying so ? if so I would say the insurance company does not have much leg to stand on , IF NOT Then I would be fighting with your docs office on this .

Mindy

[juliegeraci 7]

Fran, you are in my thoughts. Let me know what happens. Julie

[XX BeGone 0]

Hi,

I hope this all works out well for you but be very active in your fight. PUSH PUSH PUSH.

I had this happen to me about a sleep study. The problem is that I needed a 2nd study a few years after my orginal and the specialist called and set up the time and arrangements w/ me. I didn't know that because he was out of network I would have to have my PMD do the pre-auth, even though my pmd sent me to his office for an evaluation.

I trust when I am called and said "we have authorization for you study, so lets set an apt."

Any how insurance would not budge, and the specialist was trying to make me pay - w/ push and shove I was able to prove that it was his office staff's fault for telling me I was approved for the study and not mine.

Because I kept excellent documentation of all my phone calls that they finally dropped it and wrote it off.

Best wishes.

PS - don't let them try to show you the paper you sign stating that if your insurance dosen't cover you have to pay out of pocket. They tried this on me to, and i told that that is for procedures and visits when you do not have a pre auth and by law you can not charge me excess what the contracted insurance wont pay. Since they "had a preauth" I was not liable still.

[StephC 0]

I remember the girl having me sign that paper and she said it never happens, in the 10 years she's been there theres only been one or two problems with ins. coming back saying no after it had already been pre-authorized. Its a scarey thought tho. I was thinking yeah my luck I'd be that one in a million.