Denied by insurance AFTER surgery??

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#1 Post by **zoeandnimo** » Mon Mar 30, 2009 3:59 pm

What?! I swear that my surgeon's office went and had me pre-approved for this. I never would have gone ahead with this if for one minute I thought this wasn't covered by my insurance company.

Originally this was supposed to be in December and then it got pushed back to March..I'm wondering if something slipped through the cracks somehow with the switching dates??

Has anyone ever been in this situation?? How on earth would they not have known if my insurance wouldn't cover it? I'm seeing my OS tomorrow for my 2 week follow up, so I'll bring the letter with me then, but i am devastated by this. I would not have even gotten braces on 11 months ago if I thought this wouldn't be covered. Of course I will appeal but I'm just curious.

#2 Post by **monarch** » Mon Mar 30, 2009 4:50 pm

Usually for a pre-approval, your insurance company sends you a letter explaining that it is covered, or why it is not covered. There are also approximate dates for the surgery, and you must have the surgery before the dates run out (usuallly months.) If you have the letter your insurance sent you, I think that could be very helpful in figuring out what is going on. Also, give your insurance company a call. Hope it works out for you!

#3 Post by **zoeandnimo** » Tue Mar 31, 2009 8:15 am

Well, I saw the OS today and they said they definitely were told it was pre-approved - they don't even let you in the hospital unless you are pre-authorized. So whatever happened, it wasn't my fault!! Whew!! Not sure where this will go though - it definitely looks like the insurance language states that this is NOT covered, so somewhere along the way someone screwed up. Fun times.

#4 Post by **JennX** » Thu Apr 02, 2009 11:02 am

Welcome to the morass known as dealing with your insurance company. I was pre-approved, had a letter to prove it, and still had them denying payment for the claim for ridiculous reasons (stating that their records showed that a physician's assistant had performed my surgery, for example, and that it is their company's policy that a PA is not authorized to perform this procedure (DUH!)). After I got that fixed, they came up with another reason to deny, and then finally, 4 months after my surgery, they coughed up less than 20% of the reimbursement I had been told to expect pre-op. I am still fighting them on this today (see my signature line below... it's been over a year and counting). Insurance companies SUCK SUCK SUCK. Have you seen Sicko? They reward employees who find ways to deny claims, regardless of their merit, and institutionalize chaos in their record-keeping so that no two representatives will ever give you the same answer. It's a NIGHTMARE.

Anyway, hope your appeal process goes more smoothly than mine has. Best of luck...

#5 Post by **zoeandnimo** » Thu Apr 02, 2009 2:16 pm

Wow! That is crazy. I'm afraid that I'll be fighting them as well, even though they obviously gave pre-approval. My husband has said that he refuses to pay a dime for this, no matter what! I mean, I'm glad I got the surgery and all, but I wish it would have just been denied up front if it wasn't supposed to be covered! Jeez!