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Received news today that insurance will pay for my implant. Urologist called this morning and is making the surgery appointment with the hospital. This has been a long journey and now can see some hope!!

Congrats. Insurance tried to make mine a hassle.
Post when you get a date!

My advice is to let the doctor's offices do all the communications with the insurance companies, they work with this every day, they know the language and understand the insurance contracts. If you are on Medicare, you are covered.

The urologist office called me today and told me the insurance was covering it. I verified with the insurance co. Told me to get clearance from my PCP asap and they would call the hospital today and get it scheduled.

I had/have the worse experience. I got written pre authorization from my insurance and now they are refusing to pay stating its not a covered procedure!! Then whats the point of pre authorization? Its been 6 months since my procedure and going back and forth. Such a nightmare. I have escalated to even my benefits department with my company.. My provider/hospital is throwing me with a $21k out of pocket which I am not gonna pay.. I will probably end up suing the insurance company in case they dont pay..

Just make sure its completely clear so they dont go back on their promise..

Badspartan wrote:Received news today that insurance will pay for my implant. Urologist called this morning and is making the surgery appointment with the hospital. This has been a long journey and now can see some hope!!

That's great news!

I still have the voice-mail message saved on my phone from the insurance customer rep telling me they approved my surgery.

It was the beginning of hope for a change for me.

bionicbrother wrote:I had/have the worse experience. I got written pre authorization from my insurance and now they are refusing to pay stating its not a covered procedure!! Then whats the point of pre authorization? Its been 6 months since my procedure and going back and forth. Such a nightmare. I have escalated to even my benefits department with my company.. My provider/hospital is throwing me with a $21k out of pocket which I am not gonna pay.. I will probably end up suing the insurance company in case they dont pay..

Just make sure its completely clear so they dont go back on their promise..

Give it to an attorney. If the Dr received a pre auth code in writing then you and the Dr did nothing wrong.

Fyi, approving is not the same as covering the procedure.
Sil got approval for a knee surgery. Come to find out, when her employer was bought out her name was dropped from the company employee insurance plan. Payroll had even been withholding the premiums.

Floridaspeedo wrote:

bionicbrother wrote:

Give it to an attorney. If the Dr received a pre auth code in writing then you and the Dr did nothing wrong.

Thats the plan in worse case scenario. Threatening to sue who make them bend. Moreover it will blacklist them in my employer list too. A lot of my company's employees use Aetna and they dont want to mess it up.

Gt1956 wrote:Fyi, approving is not the same as covering the procedure.
Sil got approval for a knee surgery. Come to find out, when her employer was bought out her name was dropped from the company employee insurance plan. Payroll had even been withholding the premiums.

Agreed. Thats the reason its very important to make sure its is indeed covered and approved. In my case it was approved in writing and I have coverage through my employer. So my situation is different. If its not a covered procedure how did they issue a preauthorization with a code etc?