PLease help if you can... I am at a loss

[DeniseF 0]

I was banded on 12-31-08 have lost maybe 50 and feeling like a complete failur with it all.. To top it off- My insurance comapnay had come back and said they recooped all their money becasue it wasnt a covered procudure! This is after I got an approval letter and they even gave a per cert number the day before. They paid for it in March and ow took all their money back and say I owe the 35000.00! now- I cant afford it even if I sold everything in my house- What can I do- How am I going to pay this- If they garnish my checks I wont have enough to support my famly etc.. Can they do this? Can any one help me- I dont have the money for an attorney to fight them.... :drool:

[audjbr 0]

I work for an insurance company. I know a lot of times for a prior approval we are approving or denying whether something is medically necessary from a clinical standpoint, however, in our approval letters we say something to the affect that 'it's been determined that this is medically necessary. The procedure is still subject to your benefits. please call customer service to check your benefits'..something like that. But your letter sounds like they gave you what the benefits were...so that part is confusing to me..like they approved it and here are your benefits for it!...also, I am sure your provider called to verify beforehand if it was covered or not...I would talk to them as they usually have in your chart a verification of benefits sheet showing who they spoke with and what they were told. Once you get all that info together...I would call your insurance company and appeal...send in all the supporting documentation that you have!! Good Luck!

[coloradobanding 5]

In regards to the insurance company letter, don't panic! It seems that lately insurance companies make everyone, patients and providers, jump through hoops to get paid. This sounds like a scare tactic to me, and you can always appeal to the state if you think you're being treated unfairly.

Secondly, I have no idea why you would feel like a failure!!!!! It hasn't even been a year, only 8 months and you've ALREADY lost 50lbs!!!

My doctor's frame of success is at 50lbs per year, and you are already WAY ahead of that. Imagine how you would feel if you hadn't lost the 50lbs!! You are doing FANTASTICALLY and should feel fantastic as well. DO NOT beat yourself up!!

Keep your chin up and let us know what happens.

[knrpick 0]

Appeal appeal appeal!!!!!!!!!

[Unforgettable 0]

I just can't believe that they would pay for it then take it back! Perhaps I'm naive, but that's just not fair! lol

I would definitely appeal as others have said. Have you spoke with your doctor about this? I know my doctor's office has an insurance specialist and she would be the first one I'd be talking to. Hopefully this all gets resolved, but it is still such a headache.

Good luck! Keep us updated