Insurance Headache

[Guest guest]

Hi all,

Happy 4th, hope this finds you all happy and well. I'd like to take

a few minutes of your time and see if anyone else has had this

experience. I am insured by Cigna PPO. Before my surgery Dr. Hess

submitted the usual letter of medical necessity to them listing my

comorbidities and specifically stating what procedures he would be

doing. I received approval from them and had my surgery april 11th.

We started getting the statements back from the insurance company and

some of them would be paid and some would not. Thier explanations

were either that the item was over the amt allowed or that the item

was considered a component of another procedure that was already

paid. I got a statement from wood co. hospital for $21,000.00 and

then shortly after got the letter from the insurance co. stating they

had not paid because the amount exceeds the amount allowed for

this...or something like that. I know there is a statement in the

policy that says they will allow up to $5000, for treatment of morbid

obesity and I am wondering if they have " capped " ...payment on my

acct. I was under the impression that certain parts of the surgery

might be considered treatment of obesity, but things such as the gall

bladder removal, appendix, etc...were not and would be covered. And

that would also include the hospital stay. Do any of you know how to

go about getting the insurance co. to pay up on these bills?? I have

added up the bills and so far the amount not paid is over $31,000. I

fear I'm heading for the poor house! I'd appreciate any suggestions

you all might have...I know this insurance stuff is a bore and I get

completely disgusted every time I even start to try to figure it

out. PLEASE HELP ME!!! ~a

sorry for the cross post...I need all the help I can get!

4/11/01

-60 lbs