Hi, I'm Gammur. I was referred from orthopedic surgeon to Dr. Cronk, to have duodenal switch surgery in June 2015. With my current insurance at the time, I had no Bariatric coverage. With months of research and dozens of calls/conversations with insurance representatives, I finally decided on a plan from Coventry. The rep said that it covered Bariatric surgery....great! So I purchased it. But...in order for me to get that insurance, I had to move to Iowa from Nebraska. And now that I have moved...Coventry is now telling me that the surgery is not covered! But me talking to the surgeon is covered...WTH! Now what do I do?
Hi!
- Thread starter gammur
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DSRIGGS
Yes, that is chocolate covered bacon
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Hello...I can't help you with your coverage questions but there are ladies who can point you in the right direction.
I have to ask, who is Dr Cronk? I can't say I have heard of him/her as a DS Surgeon.
Welcome and hopefully you can get some direction to find a way to get your DS. Just so you know, many people travel for their DS. I myself traveled from Peoria to LA/Glendale to have my DS revised by the best in the world. BCBS covered it and the travel expense which was completely out of my own pocket was worth every penny.
I have to ask, who is Dr Cronk? I can't say I have heard of him/her as a DS Surgeon.
Welcome and hopefully you can get some direction to find a way to get your DS. Just so you know, many people travel for their DS. I myself traveled from Peoria to LA/Glendale to have my DS revised by the best in the world. BCBS covered it and the travel expense which was completely out of my own pocket was worth every penny.
Larra
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@DSRIGGS Dr. Cronk is a colleague of Dr. Anthone, just not as well known, and I have heard of him doing the DS, so that's not the problem.
@gammur hi and welcome! If you have lurked and read anything here you will know that 1)insurance problems are common, and 2) you can't trust ANYTHING some insurance company flunkie/agent tells you over the phone. So I have no idea if the first person was right or if the second person was right, and I hope you didn't relocate for no good reason, but the bottom line is that each and every person dealing with insurance MUST read his or her policy for himself/herself and not trust the phone flunkie. I seem to be posting this to someone every day these days, along with the need to keep documentation of each and every contact with your insurance company.
So for not the first time today, though first time to you, get your EOC (evidence of coverage), a huge document that tells you all the details of your coverage and also about appeals rights, if any. Without this document you don't know where you stand, and neither do we. No one here can tell you whether or not you have coverage for bariatric surgery, and if so is the DS covered, and if so is there a higher bmi requirement to get it, etc. The EOC is NOT the little summary of benefits you get when you sign up, it's about 100 pages. That's what you need, and you are entitled to it. Get that and we'll go from there.
@gammur hi and welcome! If you have lurked and read anything here you will know that 1)insurance problems are common, and 2) you can't trust ANYTHING some insurance company flunkie/agent tells you over the phone. So I have no idea if the first person was right or if the second person was right, and I hope you didn't relocate for no good reason, but the bottom line is that each and every person dealing with insurance MUST read his or her policy for himself/herself and not trust the phone flunkie. I seem to be posting this to someone every day these days, along with the need to keep documentation of each and every contact with your insurance company.
So for not the first time today, though first time to you, get your EOC (evidence of coverage), a huge document that tells you all the details of your coverage and also about appeals rights, if any. Without this document you don't know where you stand, and neither do we. No one here can tell you whether or not you have coverage for bariatric surgery, and if so is the DS covered, and if so is there a higher bmi requirement to get it, etc. The EOC is NOT the little summary of benefits you get when you sign up, it's about 100 pages. That's what you need, and you are entitled to it. Get that and we'll go from there.
DSRIGGS
Yes, that is chocolate covered bacon
- Joined
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Good....I learned something today. I guess the moved to Iowa part to get the insurance for the DS confused me as I was confusing the insurance part being in Iowa with thinking the surgeon was in Iowa (are there any, I didn't think so). I knew Anthone was in Nebraska. ...anyway, LOL......thanks for clearing that up for me.
The reason I moved to Iowa was because I went through the Marketplace for insurance. Nebraska didn't offer Bariatric coverage, but Iowa does. I am going to take Larra's advice, and get the evidence of coverage. I'm calling Coventry tomorrow.
Larra, I will call tomorrow and get the evidence of coverage. I'll be in contact with you when I get it. Thanks for your help.
I'm needing help! I had my first consultation with my surgeon yesterday. It went great! Til the insurance lady came in. She was not very optimistic about my chances of my insurance paying for the surgery. Apparently, there is an exclusion in my policy. My policy does cover 50% after deductible is met, but apparently only after survey visits. After explaining to her that I had talked to the insurance rep, and was told to have them resubmit for a "pre-authorization". She told me that it probably wouldn't do any good. How do I respond to that? Do I try get the decision over turned? I have 3 different letters from doctors saying its medically necessary to have this surgery. What should I do?
Post in this forum: http://bariatricfacts.org/forums/insurance.28/
I don't understand insurance issues but others do...and that is the best place to get help by posting in that forum so the ladies who do understand and can help can help you.
Is this the right forum to post this question?
This is the Say Hello forum that this thread is in...it's mostly for introducing yourself so others can welcome you.
The Insurance Forum is for Insurance issues (even if mentioned elsewhere).
