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About jimlaman8

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  1. We have a situation, where my wife has gone through bariatric surgery prep work.. was told by the physicians office that she should be covered if she met criteria for the surgery.. even now had a scheduled surgery date.. only to find out now that the insurance wont pay for the surgery, because bariatric surgery is not covered under any circumstance.. its an unreal situation after months of classes/pscyh evals copays and visits to find this out. I dont think this was the reason, but my employer changed ppo levels to a lower deductible / higher premium which changed insurance policies as of 11/1/2016.. much of the prep work and meetings began around oct time frame. The insurance (UPMC) certainly did not degrade in coverages. Whats strange is that the office wont call in the appeal themselves.. she had to now call the medical card number and verbally state the appeal.. they claim they dug into phone records (only phone calls) and said no one ever said it would be covered (dr office phone records), however the in person visits told a different story. At this point it feels hopeless and out of reach.. i'm not sure if a place like this advocacy lawyer could even help.. i've read it costs around $600, but if they win i suppose a small price to pay. Any thoughts/experiences?