Insurance Coverage for fills

[teamcarey 0]

Just wondering if this has happened to anyone. I had the lap band done in November and everything worked out great . My fills have always been covered. My last one wasn't covered - the insurance company explained because of the new diagnosis code because i'm not considered morbid obese anymore i'm not covered. I'm not at my goal weight, 7 lbs til i'm not considered overweight but i'm still upset that they are not paying.

How do they start something and not willing to let me finish.

I am going to appeal, so if anyone as any advice, I would greatly appreciate it.

Thank you

[neptune693 0]

I have had similar problems with codes not matching, etc. However, my solution was to take it to my benefits administrator at my company. She is amazing, and seems to straighten things out quickly without appeals. I work at a hospital, and know many people in the insurance industry; and when they told me to go see my benefits administrator I thought I'd get a big run around. However, much to my surprise, she informed me that it is her job to monitor how the insurance company manages our benefits. She meets weekly with the representative from the insurance company, and takes all employee complaints to him. If she does not get satisfaction from him, all she does is fill out an exception and forces them to process the claim.

Recently she went as far as having our insurance company change their service code for fills because there were so many complaints about the claims not being paid. Thank god I am fortunate enough to have a good benefits administrator.

So, my advice would be to start there before going throught he headache of appealing through your insurance company. Let me know how it turns out for you, and I wish you the best of luck!

Jason

[teamcarey 0]

Thank you for your help. I also work at a hospital, so i'll take your advice and start with my benefits administrator. I'll let you know the outcome.

Thanks again!

Jeannie

[TracyinKS 7]

As a benefits administrator.... RIGHT ON!

[neptune693 0]

As a benefits administrator.... RIGHT ON!

In this world we all need to justify our jobs, so the more people need us the better! I'm a cardiac monitor tech and I do everything I can to keep my job.

If you are a benefits administrator, thanks for all the work you do to help all of us workers! :-)

[teamcarey 0]

I know its been a while. Just wanted to let you all know that the benefit administrator had the insurance company pay for the fill that they said wasn't covered. They also informed me that they will cover for fills the first year of surgery even if your not considered obese.

Thanks again for everyones advice

[neptune693 0]

I know its been a while. Just wanted to let you all know that the benefit administrator had the insurance company pay for the fill that they said wasn't covered. They also informed me that they will cover for fills the first year of surgery even if your not considered obese.

Thanks again for everyones advice

That is awesome!! Glad you had success!!

[LSF 264]

What insurance do you have?