Sondra

Question for some of you. What do I need to be doing as far as my insurance. I mean the office and I both have copies of the approval letter and now that the charges have been sent it they were denied. We are talking almost 60,000.00 in charges here. The money tree in backyard isnt producing anymore! So I have been on the phone and gave them specific dates and names of who I talked to and they are pulling those calls and going from there but anything else I need to do? I am reallly starting to get worried.

Sondra

bridgetgirl

What type of insurance do you have? HMO or PPO? If it's a HMO they cant bill you. It may have been denied becuase the billing amout is excessive and they need additional information to justify reimbursement. Thats what is happening with my Plastic Surgery, the hospital billed B/C $40,000 for 3 days and surgery. It was denied because of the excessivness, so now the hospital is battling it out with the insurance. What did your EOB say? An EOB is the explanation of benefits on why it would have been denied... find out why exactly.

__________________
J.Bridget Fisher aka koi-pea
2/9/04 lap 5'11"
298/170-trying to lose another 10

www.myspace.com/caliclovercutie
What Sawyer would call me on LOST: ladybug

"People will argue with you that getting what you want in life isn’t something you can learn, if you’re destined to be one of the worlds winners as opposed to one of its perpetual whiners, its because you have been born with the right talents and temperament and have a big dose of self-esteem, ambition, and good judgment." Kate White

Sondra

Ok well here is what has happened. Leslie and I both got the approval letter from my insurance, granted there is the sentence in there that states this is not a gaurantee of payment. Well when trying to get approved for this my insurance Great West which is Healthlink PPO said it is not a covered procedure, so I was fine with that because my 2nd ins. is Aetna and I knew they would cover it. But I called back to Great West when I realized that Aetna hadnt received the fax from Leslie and I talked to a girl and asked how long it takes to get a denial letter and she asked why and I explained to her that my policy didnt cover gastric bypass and she told me "we cover it if you meet the criteria" i said even if my plan states it is not a covered benefit and she said "yes". So I am having Great West pull that phone conversation thing is I cant find all my notes but I have been out to California two times with my notebook and I imagine they are somewhere between Missouri and San Diego. So I am just guessing at a date here I am almost positive I have the correct date but it is the waiting game. My surgery was almost 60,000.00 and I am just freaking out cause my money tree never sprouted!! I have already received denial from Aetna on assistant charges stating that an assistant isnt needed for a surgery like this, can you believe that. I work in insurance billing and charge entry so I am aware of the games they like to play but it is different now that it is actually my charges being played with. It is just a big friggin mess and 60,000 is a lot of money that I DONT HAVE!!!! So everyone cross their fingers for me. Ya know if it came down to it I would come up with Dr. Callerys part for the simple fact that he is the only doctor that would even talk to me about this surgery since I have Factor V Leiden, that is why I flew to San Deigo to do it. God Bless that man, he is GREAT!!!!!!

Sondra

Americanwoman397

Sondra

You know what I believe if its meant to be it will be. Your surgery was meant to be so it happened and they'll get all the payment stuff worked out. Good luck with it all and you know we are all here if you ever need to just blow off some steam.

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Tonya
Dr. Potts
7/16/2004 Lap
320/164
48.66/25.68 BMI

bridgetgirl

Nobody not the hospital or the surgeon would have agrred to do the surgery unless they had some form of auth, and gurantee for payment..... sounds like Leslie is the one that should be digging through notes to see what to do now...... good luck Sondra!

__________________
J.Bridget Fisher aka koi-pea
2/9/04 lap 5'11"
298/170-trying to lose another 10

www.myspace.com/caliclovercutie
What Sawyer would call me on LOST: ladybug

"People will argue with you that getting what you want in life isn’t something you can learn, if you’re destined to be one of the worlds winners as opposed to one of its perpetual whiners, its because you have been born with the right talents and temperament and have a big dose of self-esteem, ambition, and good judgment." Kate White

Christina

I am sorry you are going through all of this. I am crossing my fingers for you and planting a money tree for ya too.. I don't know if or when it will ever bloom.. but I will keep an eye out for some sprouts from it ok?

That is a lot of money and hastle to go through while you are recovering. I wish there was some magic trick we could do to get this sorted out.

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Christina
Open RNY 03/31/2004
274/128/137 (131 Per Dr. C)
BMI: 47 / 22

"There's nothing noble in being superior to your fellow men. True nobility is being superior to your former self." - Ernest Miller Hemingway

"Obstacles are those frightful things you see when you take your eyes off your goal." - Henry Ford

watergirl

GEEZZZZZZ Girl. I've got everything crossed for you to get that $60K taken care of by insurance. Keep us posted on your progress.

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Kim
On the road of life, it's not where you go, gut who's by your side that makes the difference.

Wherever you go....there you are.

Wrinkles only go where the smiles have been. - Jimmy Buffett

Lap RNY 8.9.04
266/130
Start BMI 41.6
Current BMI 19.9 I'm finally NORMAL! No longer Morbidly Obese, Obese or Overweight!

Myspace: My URL
http://www.myspace.com/h2o_woman