Insurance said YES, now said NO...please help, need advice

[Guest guest]

> Hi everyone,

>

> So get this...I was scheduled and confirmed/approved for 4 parts of

> this surg. 8/9 and also an overnt stay. The parts were upper AND

> lower reconstruction, oral surgical services and lastly

genioplasty.

> Oh and I have Vytra, pos.

>

> So, when I got the apprvl letter recently and was talking to a rep,

I

> asked what the codes were and she told me. I was like REALLY!?

> Approved for Genio too? YES was the answer.

> I recall the the os said they may consider that " unnecessary " and

> cosmetic, so I may have to cover that-a near $4000 mind you. So I

> asked the rep--are you sure???? YES. (good!)

> I was also told that if I had to pay this, I needed to do it PRIOR

to

> the surg --in short, no $, no genio surg. (mind you-told to me more

> nicely than I write now)

> So I called the OS-ins person...Check this out...I don't have to

pay

> you, they are, I said. She doubts me and says, REALLY?? That

doesn't

> sound right...I will call them and check.

> Ok.

> Got a letter again, approval for the same as I did last time, upper-

> lower-genio-os serv. 2 letters...same stuff--good!

>

> waiting...she still hadn't heard at their office.

> that was weeks ago. waiting, waiting.........another letter,

> approving 2 nts if necessary.

> then she calls me last thurs to say, they went ahead and did

approve

> 2 nts if nec (I was down as an out pat and they NEVER said that in

> prev talks-always 2-4 nts?! so she called and changed it----

whatever-

> maybe that's why this happened...ha, that would be something)

>

> last nt, after a really difficult 2 days-just in life in general,

I

> get my mail--BIG LETTER from Vytra. After " re-review " -

NOPE...changed

> their minds and they ARE NOT COVERING IT-the genio-AT ALL.

>

> Pardon, but what the BLEEEEEEP!?!!!??

>

> I feel so shafted. I get all these yes letters and reps on the

phone,

> then the os office checks and NOPE.

>

> What's your take? Are they trying to get more $ from me than the

ins

> co? Can the ins co give then take-ith it away?? With no new info or

> files of my case...how do you make 2 diff assestments on the same

> info????

>

> I could cry.

> scream.

> I'm just so frustrated. it's 2.5 wks until and what a curve ball.

>

> What do I do? bec, I want to discuss this with someone...

> HELP! please....jo

> (sorry if this is a repeat, I posted on both sites bec I really

need

> some good ideas and info here...thanks!)

[Guest guest]

Wow...i'd definitely be pissed off at the insurance company. Since

you've already gotten all of those insurance letters saying you were

approved for the genio...would it be worth arguing and trying to get

them to stick with their original decision to include it as part of

the surgery expenses? i know insurance companies are well known for

screwing people over and trying to be sneaky or whatever. that's

just really strange though. i'm having my surgery the beginning of

august...and i'm getting a genio as well. but i was told from the

beginning that it would not be covered under insurance since it's

considered a cosmetic procedure ($2500). it sucks though...because

even if you try to argue it...the insurance company always wins...ya

know? but i'd give it a shot anyway. and in my own opinion...yeah

maybe it's sorta a cosmetic procedure...but it could also be

considered a deformity in a way. i mean mine isn't as bad as

others...but i think it should be looked at as surgery to correct a

deformity in your face. i mean isn't that eye surgery to to correct

your vision covered under insurance?? well that's not necessary

either...you could still wear glasses without a problem...so you

dont' " need " the eye surgery. grrr...insurance companies just don't

make sense sometimes.

Tom

> > Hi everyone,

> >

> > So get this...I was scheduled and confirmed/approved for 4 parts

of

> > this surg. 8/9 and also an overnt stay. The parts were upper AND

> > lower reconstruction, oral surgical services and lastly

> genioplasty.

> > Oh and I have Vytra, pos.

> >

> > So, when I got the apprvl letter recently and was talking to a

rep,

> I

> > asked what the codes were and she told me. I was like REALLY!?

> > Approved for Genio too? YES was the answer.

> > I recall the the os said they may consider that " unnecessary " and

> > cosmetic, so I may have to cover that-a near $4000 mind you. So

I

> > asked the rep--are you sure???? YES. (good!)

> > I was also told that if I had to pay this, I needed to do it

PRIOR

> to

> > the surg --in short, no $, no genio surg. (mind you-told to me

more

> > nicely than I write now)

> > So I called the OS-ins person...Check this out...I don't have to

> pay

> > you, they are, I said. She doubts me and says, REALLY?? That

> doesn't

> > sound right...I will call them and check.

> > Ok.

> > Got a letter again, approval for the same as I did last time,

upper-

> > lower-genio-os serv. 2 letters...same stuff--good!

> >

> > waiting...she still hadn't heard at their office.

> > that was weeks ago. waiting, waiting.........another letter,

> > approving 2 nts if necessary.

> > then she calls me last thurs to say, they went ahead and did

> approve

> > 2 nts if nec (I was down as an out pat and they NEVER said that

in

> > prev talks-always 2-4 nts?! so she called and changed it----

> whatever-

> > maybe that's why this happened...ha, that would be something)

> >

> > last nt, after a really difficult 2 days-just in life in

general,

> I

> > get my mail--BIG LETTER from Vytra. After " re-review " -

> NOPE...changed

> > their minds and they ARE NOT COVERING IT-the genio-AT ALL.

> >

> > Pardon, but what the BLEEEEEEP!?!!!??

> >

> > I feel so shafted. I get all these yes letters and reps on the

> phone,

> > then the os office checks and NOPE.

> >

> > What's your take? Are they trying to get more $ from me than the

> ins

> > co? Can the ins co give then take-ith it away?? With no new info

or

> > files of my case...how do you make 2 diff assestments on the same

> > info????

> >

> > I could cry.

> > scream.

> > I'm just so frustrated. it's 2.5 wks until and what a curve ball.

> >

> > What do I do? bec, I want to discuss this with someone...

> > HELP! please....jo

> > (sorry if this is a repeat, I posted on both sites bec I really

> need

> > some good ideas and info here...thanks!)