Question:
I have posted this question a few days ago and I cannot understand
why I am getting very rude private emails...My company has an exclusion for gastric bypass, I am in need of a revision..Of oucrse when we submitted it the first time, I was denied..When I went back to my surgeon and told him I was going to mortgage the house so I could have the surgery done..he said he would do it for free, because my failure at this surgery was his failure as well..and he doesnt like to fail--he didnt mess the surgery up..I did..I messed up and he is giving me a 2nd chance..my ;ast chance--my question was would it make the difference for the surgery to be approved if the surgeon is doing it for free?? Does any one know? — tylerswife (posted on May 18, 2005)
May 18, 2005
I'm no insurance professional, but insurances are in the business to make
money and if your surgeon didn't submit a claim, I wouldn't think they
would go hunting him down demanding he send them a bill... LOL Know what I
mean? They want to keep their money so if your surgeon doesn't bill them
for the procedure, I wouldn't think they would say anything. I would say
the procedure being covered or not is going to be based entirely on the
wording of your policy with the insurance company. Have you tried posting
this on the Insurance Help message board? Maybe someone there will also
have an answer. I don't know if I helped or not, and again, I'm no
professional. Regardless, good luck with your approval, and good luck with
your revision. :)
— Shayna T.
May 18, 2005
I would say you are very lucky to have a surgeon willing to do this for
you, so let him. I also think (I don't know for sure) if you tell the
insurance company that he's doing it for free they'll say let him and it
won't change anything for them. Is 'free' going to include the hospital
stay and anesthesiologist as well? If not, do what you have to do to pay
that part, be very grateful that the surgeon's fee is comp'd, and REMEMBER
this! Like you said, your last chance. Be gentle with yourself this time
around. Don't 'mess it up'. You CAN do it. I should be telling myself
the same thing, I suppose. I self paid my entire surgery 3 years ago (and
I'm still paying for it every month), and I haven't been so good to myself
of late. I should take my own advice. Good luck to you! Kelli
— KelBurt
May 18, 2005
Why do you need it approved if it's free? Is it the hospital costs you're
trying to get covered?
— scbabe
May 18, 2005
When I was going to go self-pay, the surgeon told me that if anything went
wrong (on his part) and I didn't lose or something worse happened, he would
do a revision for free also. "Free" in this case meant the
hospital, anesthegiologist, etc. You might want to get a straight forward
answer (and maybe in writing) of what 'free' to him means. Good luck!
— Nicki F.
May 18, 2005
Rebecca, I answered this the last time you asked this question. No, it
does not make a difference. Insurance companies approve procedures, not
individual charges. What this means is that in order to get insurance to
pay for your hospital stay they will need to approve the procedure being
done, regardless if the surgeon doesn't charge. The hospital submits
charges based on the procedure being perfomed.
— RebeccaP
May 19, 2005
you need to also consider, if you have complucations and the original
procedure was not approved, you will likely be responsible for all charges
for the complications. I would work real hard to get those hospital charges
covered. I find it unlikely the Dr would cover OR , anesthesia, room
charges etc.
— **willow**
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