Question:
Has anyone gotten this?
I received my approval letter today. I was so excited, but, then I read a paragraph stating Please understand that this determination is not a guarantee of coverage or reimbursement, and should not be relied on as such. All reimbursement decisions are made strictly in accordance with written plan provisions blah blah blah. Has anyone ever gotten this and can you tell me what it means? Am I approved or not? The first paragraph says it appears that the RNY is covered under the provisions of this patient's medidcal plan. HELP -- HELP -- HELP — Jen L. (posted on December 14, 1999)
December 14, 1999
WELL I'M NOT SURE IF THIS WILL HELP..... BUT HERE GOES MY INSURANCE CO.
APPROVES WLS UNDER CERTAIN CONDITIONS LET ME TRY TO EXPLAIN WLS IS A
COVERED BENIFET FOR MOST INSURANCE CO BUT YOU HAVE TO QUALIFY FOR THE
PROCEEDURE FOR YOU TO BE COVERED THIS SOUNDS CRAZY BUT YOU GO THOUGH
DIFFERENT STAGES OF APPROVAL ONE STAGE SAY'S YES THIS IS A COVERED BENIFET
THEN SAYS NOW PROVE TO ME YOU QUALIFY FOR IT WHICH YOUR DOCTOR CAN DO FOR
YOU I WOULDNT WORRY TO MUCH BUT I WOULD CONTACT THE INSURANCE COMPANY AND
TALK TO THEM THEY ARE THE ONES WHO CAN EXPLAIN IT BETTER TO YOU..... SORRY
IF I CONFUSED YOU IN ANY WAY.........HOPE THIS HELPS
— Ann F.
December 14, 1999
Hi, my 'approval' letter stated the same thing. (BC/BS) I am now 7 weeks
post op as of today. I haven't received any bills saying I owe anything.
Just statements of what was sent to the insurance company. Sounds like you
are on your way! Congratulations!
— Sarah D.
December 15, 1999
I got the same letter from BS/BC. I called them and was
assured that I was covered. Then after surgery I got a
statement of benefits denying payment because the surgery
was obesity related. I was told, when I cslled BS/BC that
the forms would have to be resubmitted using different
'codes'. If BS/BC doesn't pay I will owe my surgeon
over $5,000 and the Anesthes. over $2000. I've contacted the
surgeons office and they have agreed to resubmit. I keep calling
the other doctors office and nobody ever answers the phone.
I'm still waiting for more statements to see what has been
decided. BC/BS paid all but $10 of the hospital bill. The
$10 was for a private room that they insist I didn't need
even though the Doctor requested it, not me. Hope this helps.
— kaydeeb16
December 15, 1999
My understanding is that no insurance company will GUARANTEE anything.
Approval or pre-authorization seems to be standard wording. They won't
even GUARANTEE to pay for what they say they will in their brochures! That
word is not in insurance vocabularies!
— vitalady
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