Insurance SNAFU

happyteacher
on 12/23/11 2:34 am
 So I was sleeved on Monday the 19th.  My surgeon was given the preauthorization form, they told me it was preauthorized about two weeks before the date.  Today in the mail I recieve a letter from my insurance dated the 20th saying that they can neither confirm nor deny the surgery as they cannot preauthorize a surgey that is already completed.  I am so not paying this bill if the insurance doesn't come through, and I have NO IDEA what happend!!  I have excellent insurance overall so I just have to have faith that it will work out!

Surgeon: Chengelis  Surgery on 12/19/2011  A little less carb eating compared to my weight loss phase loose sleever here!

1Mo: -21  2Mo: -16  3Mo: -12  4MO - 13  5MO: -11 6MO: -10 7MO: -10.3 8MO: -6  Goal in 8 months 4 days!!   6' 2''  EWL 103%  Starting size 28 or 4x (tight) now size 12 or large, shoe size 12 w to 10.5   150+ pounds lost  

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bigmama3
on 12/23/11 2:52 am

The doctor should have received a preauthorization confirmation number from the insurance carrier.  Hopefully, they have one...as long as a number exists, the letter doesn't mean anything.

good luck.

    

CW - 125 (20 lbs. below goal)

ruggie
on 12/23/11 2:52 am - Sacramento, CA
 You shouldn't freak out, nor should you have faith it will magically rectify itself. While it sounds like a typical clerical error, just pick up the phone and call them.

     

Heaviest weight:  310 pounds  (Male, 5'10")

trayb17
on 12/23/11 3:10 am
VSG on 01/05/12
If the surgery is a covered benefit then pre-authorization may not be required. I have a BC/BS PPO of MI plan and they told me that pre-authorization for covered benefits was not necessary but I know every plan is different. I would call the surgeon's office and then the insurance company. By the way, your surgeon was one of my choices for the sleeve...however, I ended up choosing Dr. Krause as someone I know was sleeved by him...I believe our surgeons are in the same hospital bariatric program.
happyteacher
on 12/23/11 5:25 am
 Hi Tracy,

Yes, our docs are in the same program.   There is a personal connection to your doc that I wanted to avoid- nothing at all against his skill level :)  I will call the office to follow-up.  I guess I feel like at this point the surgery is done- it is not like they can take it back!

Surgeon: Chengelis  Surgery on 12/19/2011  A little less carb eating compared to my weight loss phase loose sleever here!

1Mo: -21  2Mo: -16  3Mo: -12  4MO - 13  5MO: -11 6MO: -10 7MO: -10.3 8MO: -6  Goal in 8 months 4 days!!   6' 2''  EWL 103%  Starting size 28 or 4x (tight) now size 12 or large, shoe size 12 w to 10.5   150+ pounds lost  

Join the Instant Pot Pressure Cooker group for recipes and tips! Click here to join!

happyteacher
on 12/23/11 5:27 am
 Tracy, 

A question on a different note for you.  Have you attended the support group offered by the hospital?  If so, do you feel it is worthwhile?  My insurance is also BCBS PPO (Messa) so it is good to read yours is all set- a good indicator for me that it is a simple fix.  

Surgeon: Chengelis  Surgery on 12/19/2011  A little less carb eating compared to my weight loss phase loose sleever here!

1Mo: -21  2Mo: -16  3Mo: -12  4MO - 13  5MO: -11 6MO: -10 7MO: -10.3 8MO: -6  Goal in 8 months 4 days!!   6' 2''  EWL 103%  Starting size 28 or 4x (tight) now size 12 or large, shoe size 12 w to 10.5   150+ pounds lost  

Join the Instant Pot Pressure Cooker group for recipes and tips! Click here to join!

trayb17
on 12/23/11 6:52 am
VSG on 01/05/12
No I haven't attended yet. I picked up a schedule the other day, but when I got home I realized that the dates listed were for next month...starting the new calendar year. My intention was to attend a meeting before my surgery. Anyway, I do plan to go when I am feeling up to it after sugery.

I was wondering how your hospital stay was and whether or not you had a room mate. Of all the questions I asked, I forgot to inquire about private rooms . Hopefully I will only be there one night.
happyteacher
on 12/23/11 11:33 am
 I felt overall I had excellent care-- in some ways too good!  I had somebody checking vitals or asking questions or something else constantly.  Due to my hernia repair my back pain made it tough to get comfortable, tough to fall asleep.  Once figured out how to fall asleep a bit, they would have to wake me up.  Not complaining- they were doing their job and it made me feel like if anything was to go amiss it would be caught immediately.  

I did have a roommate.  At first I was bummed, as I am a super light sleeper.  Then after a bit I realized the staff would wake me up anyway!  She was incredibly considerate- had the t.v. on all night, but barely any volume.  Overall it was  nice to have somebody to chat with a bit.  I am not big on roommates either, but it was very doable.  

They kinda wanted me to stay a third day, offered it over and over and over... I had nausea and a little trouble getting down much of the first full liquid meal.  Also a little trouble with the spiromenter, as the hernia repair was making it tough to take deep breathes.  I elected to go because I thought better quality rest would help, and that I would be attended to very well by the family.  Good decision :)

Overall, the care was excellent and you have nothing to worry about on that end.  I also have no idea of a private room was an option or not.  The crazy thing?  A patient down the hall had her dog there- WTF!  Good little poochie, stayed in the room and I never heard it bark.. but eewwww!

Surgeon: Chengelis  Surgery on 12/19/2011  A little less carb eating compared to my weight loss phase loose sleever here!

1Mo: -21  2Mo: -16  3Mo: -12  4MO - 13  5MO: -11 6MO: -10 7MO: -10.3 8MO: -6  Goal in 8 months 4 days!!   6' 2''  EWL 103%  Starting size 28 or 4x (tight) now size 12 or large, shoe size 12 w to 10.5   150+ pounds lost  

Join the Instant Pot Pressure Cooker group for recipes and tips! Click here to join!

trayb17
on 12/23/11 11:41 am
VSG on 01/05/12
Ok, I can't believe a dog was there...WTF is right!?! I checked out several other programs and some of them offered private rooms for bariatric patients. I snore so I always feel like I am going to disturb a roommate. Thanks for the hospital info...I'll let you know if I see any dogs, , LOL
Morgan S.
on 12/23/11 7:20 am - El Cajon, CA
VSG on 01/20/12
If your hospital/dr are CONTRACTED with your insurance they should not be able to bill you. Where I work, if our contracted doctors provide services PRIOR to recieving authorization, they are not able to bill the patient. But that is just the contracts that my company makes the providers sign, all health plans are different.

However,
I would call, call, call until this is taken care of. Insurance companies take complaints from its members much more seriously than its providers. Hope that helps!
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