I Have a Surgery Date, but...

[Pink Unicorn]

Good news - I have a surgery date - Tuesday, August 1st.

Bad news - Insurance denied the surgery, and I've been getting the runaround (ish) and various answers when I call. I finally got ahold of someone and got the appeal process started. But I am worried that the denial will stick.

So now I'm scrambling to come up with money to pay for this before August 1st, because at this point the surgeon is probably booked up until October. And I don't want to wait a single, freaking day longer than I have to.

To say I'm stressing over the situation is an understatement.

 

[DianaCox]

No promises, but @Larra and I just helped someone win their appeal who did this - got denied, self-paid, appealed and finally won on external review. If you were going to win your case eventually, you should win it whether or not you self-paid after getting a first denial - a first denial vests your right to appeal (within a certain time-frame).

If you want our help, start collecting the following documents:

• Your Evidence of Coverage (about 100 page document that is the contract between your employer and the insco - not a summary of benefits), including the details of the bariatric coverage requirements
• The denial letter
• The request for preauthorization from your surgeon

When you have those, PM Larra and me and we'll give you our email addys to send the documents to.

 

[Larra]

Also, you probably have figured out by now that you can't rely on anything some random customer service employee tells you over the phone. Insist on having everything in writing. Save everything. When you do have a phone conversation with anyone from your insurer, keep a record documenting date, time, name and job title, phone number, and summary of conversation. Request (demand, nicely) to speak with supervisors when necessary.
and as @DianaCox said, we can never make promises, but a lot of appeals are successful and you certainly have nothing to lose by appealing.