my friend was denied

[jewels41 0]

Hi all my friend called me and told me that her insurance which is Medica has denied her. I told her to call and find out why so she did and they told her that they do not cover lap band surgery. She had called ahead of time to see if they did and she was informed that they do. I told her to appeal and the lady is sending her that paperwork , but the lady told her not that its going to do her any good. Anyone else have a problem like this? Can anyone offer any advice on what she should do other than appeal...

thank you

Julie

[Jodi_620 37]

Yes, the same thing happened to me. She should have gotten a copy of the policy showing what is covered or requested something in writing. I had the same problem with my previous insurance, I called and they said over the phone that surgery is covered but when my surgeon submitted they said they don't cover it. Unfortunately a lot of misinformation is given over the phone. It turned out that my insurance policy did not include bariatric surgery and the woman I spoke with gave me inaccurate info. Luckily I was able to switch to DH insurance and have it covered.