Re: Insurance said YES, now said NO...for TOMstap

[Guest guest]

Quick Q...

where are you located? (About)...bec I was quoted over

$3500...curious if it's regional or just digging deeper into my

pockets...

THANK you. I really needed to hear from people who are IN

this...thanks again. jo

> > > 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]

I live in the Indianapolis, Indiana area. Yeah...that's a lot higher

than what I was quoted!!!

> > > > 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]

Hmm, very interesting...Will take that under advisment ABSOLUTELY!

> > > > > 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!)