This might be long, I'm sorry, but you guys give great advice and I've tried everything that I can think of.
I was uninsured from 5/15/08 to 8/11/2008. I purchased a student policy through United Healthcare (UH) through my college which became effective 8/12/08.
I got pregnant, started to have issues with what I thought was heartburn until I landed in the ER and found out it wasn't horrible heartburn, it was gallstones and my gallbladder needs removed. This was 1/24/09.
ER referred me to a surgeon, I met with him, he wouldn't operate until I had my baby. Insurance paid both claims- the ER, the consult.
FF to now, I have UH still and also have insurance through my husband, GEHA. It became effective 4/26/09. I went for another consult with my surgeon, scheduled the surgery for Thursday and now they're canceling it on me.
The nurse called UH and they told her it was pre-existing. I called them back and they told me it was NOT pre-existing, as I was covered under the policy whenever the diagnosis was made. I called to tell her that, she said OK but then called me this morning to say the surgery center denied it because UH told them (twice!) that it was pre-existing.
I called UH and they still tell me a) they couldn't release the information of it being pre-existing or not as that is a violation of HIPAA and b) it's covered. So I called GEHA and they said "Nothing is pre-existing with us, if UH denies it we'll pay." The lady I spoke with even called her higher up to confirm.
The surgery center will not call my secondary as "If primary denies, secondary will deny."
My surgeon's nurse called to say they canceled the surgery and I could always "Go to the ER, complain of uncontrollable pain, have all the workups done again and hope the on-call surgeon will operate."
....I'm really frustrated right now.
Anyone have any idea what I can do next??
I was uninsured from 5/15/08 to 8/11/2008. I purchased a student policy through United Healthcare (UH) through my college which became effective 8/12/08.
I got pregnant, started to have issues with what I thought was heartburn until I landed in the ER and found out it wasn't horrible heartburn, it was gallstones and my gallbladder needs removed. This was 1/24/09.
ER referred me to a surgeon, I met with him, he wouldn't operate until I had my baby. Insurance paid both claims- the ER, the consult.
FF to now, I have UH still and also have insurance through my husband, GEHA. It became effective 4/26/09. I went for another consult with my surgeon, scheduled the surgery for Thursday and now they're canceling it on me.
The nurse called UH and they told her it was pre-existing. I called them back and they told me it was NOT pre-existing, as I was covered under the policy whenever the diagnosis was made. I called to tell her that, she said OK but then called me this morning to say the surgery center denied it because UH told them (twice!) that it was pre-existing.
I called UH and they still tell me a) they couldn't release the information of it being pre-existing or not as that is a violation of HIPAA and b) it's covered. So I called GEHA and they said "Nothing is pre-existing with us, if UH denies it we'll pay." The lady I spoke with even called her higher up to confirm.
The surgery center will not call my secondary as "If primary denies, secondary will deny."
My surgeon's nurse called to say they canceled the surgery and I could always "Go to the ER, complain of uncontrollable pain, have all the workups done again and hope the on-call surgeon will operate."
....I'm really frustrated right now.
Anyone have any idea what I can do next??
