Question:
Has anyone every been preapproved and then had insurance refuse to pay?

I thought I was all set. I got my preapproval in December for February surgery. All of a sudden, I got notice from my insurance company (United Health Care PPO) stating they don't cover weight loss surgery! Apparently, when the policy was re-written on January 1st, an exclusion was put in. So, now they don't want to pay. Has anyone had this happen to them? If so, what did you do and did you win? I don't quite now where to go with this. Thanks.    — kathyb (posted on March 22, 2003)

March 22, 2003
Kathy, Blue Cross Blue Shield of Alabama approved my surgery with a surgery date of September 20, 2002. My doctor and myself received a letter of approval from them stating that I had a year from the date of the letter to have my surgery done. Well a couple days later my doctor's office called the local hospital and told them to schedule the surgery. The hospital call BCBS and asked them what would be my deductable amount. BCBS told them that they had made a mistake and they would under no circumstances pay for the surgery! Go figure! I tried everything under the sun to try and get BCBS to reverse their decision, but to no avail. BCBS told the hospital that in the future they might consider covering this surgery at a later date. BCBS said this was a decision of my employer because they are a self funded insurer and BCBS administers the policy for my employer. Hope this helps
   — Gene F.

March 22, 2003
I was approved on the 19th of September (got the approval on the 21st). Insurance changed on the 1st of October (didn't know this.) Called on the 7th of October and told that there was an exclusion. I told them that I was already approved. The thing who answered the phoneline that day for me told me that they would have paid for the surgery had I had it prior to October 1st. I told her so basically I was supposed to know that I had 9 days, 4 of which were weekends to have surgery. She said yes. I hung up. Called my insurance coordinator at work, who said she hadn't heard that the policy was changing. She gave me the phone number of our insurance broker. Basically I went through insurance hell from October 7 until now. (I AM covered. I FINALLY got a certificate of coverage (my company didn't have one for 6 months because they were arguing over benefits with Anthem. My company didn't want the coverage to change.) Anthem has denied surgeon payment saying that they need more info now. (AFTER I've had surgery.) Good luck, don't give up, and call your work.
   — Michelle B.

March 22, 2003
If you were approved before the exclusion I wouldn't worry about it.I know from my experiences with my insurance company that all of the different departments like authorization and billing are not always "on the same page".The billing department may not be aware of your authorization date.I would simply let them know that you were approved before the exclusion and send them anything stating your approval that recieved in writing.
   — jennifer A.

Click Here to Return