Need some advice.... - ThinnerTimes

Barb1024 · 12-18-2006, 08:21 AM

I've been reading alot on here about appeals to insurance companies and most of you who are appealing are pre op. Well I am post op, and decided to pay out of pocket for my WLS because my insurance company states that bariatric surgery is an exemption. I had all the doctors submit claims everytime I went to see them and also had the hospital submit a claim to the insurance for the surgery which of course was denied. I am still wanting to appeal in hopes that maybe some of my money may get reimbursed. Have any of you appealed AFTER you had surgery and if so, what steps did you take?
I know there is a place in S. California that deals with the appeal process and "for a small fee" they will deal with the insurance company.....do you think "the small fee" is worth paying,,,I think it is between $800 to $1200 to retain them...They are obesity lawyers.
If you think I have a leg to stand on,,,can you give me some advice on how to start the appeal and maybe some advice on how to even start an appeals letter...
I am content even if the insurance company doesnt pay anything because having WLS was the best decision I've ever made and it was well worth the money,,,but I think I should at least try to gain something back

coptergirl · 12-18-2006, 08:23 AM

Not to burst your bubble, but of there is an exclusion to weight loss surgery, generally insurance companies mean it. You might be able to consult with the lawyers free for the first visit to see if you have a leg to stand on, and then you could go from there...good luck, and let us know how it goes...

sdgrrl · 12-18-2006, 08:31 AM

It;s downright criminal, but a hospital will accept as much as a 50% discount from an insurance company, but if you are self pay, you owe the whole nugget. So the attys at the recovery center may very well meet with resistance, with the hospital saying, "What, we got paid every dime!" and just try to get back enough change for a phone call....

It just blows me away that companies would rather pay for all the comorbs and their effects than making the problems go away!

coptergirl · 12-18-2006, 08:32 AM

Quote:

Originally Posted by sdgrrl

It;s downright criminal, but a hospital will accept as much as a 50% discount from an insurance company, but if you are self pay, you owe the whole nugget. So the attys at the recovery center may very well meet with resistance, with the hospital saying, "What, we got paid every dime!" and just try to get back enough change for a phone call....

It just blows me away that companies would rather pay for all the comorbs and their effects than making the problems go away!

I agree - it is infuriating!!!