Brides Helping Brides ™ - I need some serious serious advice!!!

aliciahelene Posted: Jun 05, 2004 09:58 AM

I need some serious serious advice!!!

I am scheduled to have a small surgery on monday at 745 am. Yesterday, My husnband comes home with a letter from his job saying that as of June 1( meanwhile we get this letter in the 4th) that our insurance has switched and we will be getting cards in the mail with a new insurance company. I call my Doctors office this morning, they no longer take my new insurance, my new insurnace isnt open on wekeends so we cant even call to see if they'll approve me to still have the surgery...my doctors office said what my husbands job did is illegal...I am freaking out...really freaking out. Iasked what this would cost for us to just pay for it out of pocket and they said thousands because its in a hospital ,anesthesia is involved...im freaking out.....what do i do????HELLLLPPPPPP

prncssrachel Posted: Jun 05, 2004 10:02 AM

Re: I need some serious serious advice!!!

OMG, that is AWFUL. Can you postpone the surgery? (NOT THAT YOU SHOULD HAVE TO BECAUSE IT IS THEIR MISTAKE!) I have no clue what to do. I'm so sorry!

kdelace Posted: Jun 05, 2004 10:09 AM

Re: I need some serious serious advice!!!

can you postpone it until the end of the week. not that you should even have to- your health is more important than money but i would be stressed over it also. im so sorry you're going through this in addition to having this surgery done. im thinking of you...

aliciahelene Posted: Jun 05, 2004 10:17 AM

Re: I need some serious serious advice!!!

Thanks ! Im so friggin stressed! Im trying to see what my options are, my husband is trying to get ahold of his boss to see whats going on, if they can help us

kpny622 Posted: Jun 05, 2004 10:21 AM

Re: I need some serious serious advice!!!

I don't know the laws, etc. but it seems to me that they would need to give you more notice than that. What if you already had the surgery on June 2? Then would you be covered or not? Makes no sense. My company recently switched all our benefits, and we got hundreds of memos and warnings and notices long beforehand.

aliciahelene Posted: Jun 05, 2004 10:23 AM

Re: I need some serious serious advice!!!

I agree, the docors office said this is illegal what my husband s work did, we got the letter YESTERDAY evening..its dated June 4th, but says as of June 1st, we no longer have that insurance...this is awful

gertyrae Posted: Jun 05, 2004 11:58 AM

Re: I need some serious serious advice!!!

If I were you, since it is Saturday, I would contact the NEW insurance company and explain what is going on. All the paperwork must have been completed already. I am pretty sure what your surgery is, since I had a couple of years ago, and you should have gone in for pre-surgical testing a few days ago. Let the new insurance company know what is going on, and if possible contact the hospital where the surgery is being done and talk to them about it. I am pretty sure the doctor has nothing to do with it once it goes to the hospital, aside from his bill being added to the hospital bill.
I really want to wish you luck, this is horrible...and yes it was illegal. But you should still have the surgery, and postponing it is only going to make things more difficult for you.
Good luck, you are in my prayers!!

aliciahelene Posted: Jun 05, 2004 01:11 PM

Re: I need some serious serious advice!!!

Thanks gertyrae...I cant contact customer service because they are closed. They open up on Monday..and my surgery is for 745 AM. Ive been on the phone all morning and what my Doctors office said I should do is not cancel it, my cells are high grade now and they dont want to postpone this any longer, they said they will most likely do whats called a continuing treatment, because thsi surgery was booked before the insurance switch and because its necessary, my old insurance will most likely still cover it. If not, my husbands boss thinks we can still use out of network benefits, where we will have to pay 20%, which should still be over a thousand...but the Doctors office is pretty sure I can get a continuation. So Im just going in monday, getting this over with and then Ill be prepared to fight afterwards if necessary. UGH>>Im going to bed now.,..have been up all night But thanks for all of yoru nice words!!

dm24angel Posted: Jun 05, 2004 01:11 PM

Re: I need some serious serious advice!!!

you have fm

dm24angel Posted: Jun 05, 2004 01:17 PM

Re: I need some serious serious advice!!!

I work for a LARGE health insurance company and as far as I can see, if your husband didnt sign a contract what they did was wrong....the new insurance company may approve the surgery because it was planned....I dont know if they will though, its a long shot....also, I sent you FM decribing the situation with the procedure....you could postpone it....I was scheduled to have it in the hospital, freaked out and decided to find a dr (even though I loved mine) who would do it in office...I ended up having a consult with the new dr and scheduled the procedure almost 4 months after the original one ( and my situation was I think a little worse then yours) and they were not overly worried....So seriously think about trying to get another dr so you wont pay out of pocket...I can even give you the specialist name , maybe they take your new insurance?

When you call the new insurance, ask them for whats called an in for out...you would first ask your current dr if they will except what the new insurance will pay and not balance bill you, if they say yes, then you call the current insurance and ask them if they can do this for you due to it being already scheduled....( only time this might not work is if you have an HMO with the new company)

Good luck...let us know what happens...

aliciahelene Posted: Jun 05, 2004 01:24 PM

Re: I need some serious serious advice!!!

I sent you FM and THANKYOU for your FM..made me alot less nervous!!!!
At this point..I just want to get it over with, I start school summer classes next monday. I know my health is most important...but I just want this over with. Im going in Monday, have them do it and meanhwile monday morning, my Doctors office will be calling my new insurnace and working something out. They are pretty confident that it will be covered since this is preexisting or whatever. We have a PPO and not an HMO, so we should be ok. We were with Guardian/ health net and now we have Aetna Us health care. I have the letter that my husbands job gave us of how they notified us of this swtich, AFTER the fact..so Ill fight this if I have too!!! Thanks so much again for your FM Dm24angel! and for the advice!

Maribelle7777 Posted: Jun 05, 2004 01:25 PM

Re: I need some serious serious advice!!!

I'm surprised that the insurance is not open on weekends. Some ins co's are horrible!!!

Is there a way you can postpone the surgery so you can find out what's going on? Or would your old surgery cover it because they failed to inform you beforehand of the switch?

Good luck

aliciahelene Posted: Jun 05, 2004 01:30 PM

Re: I need some serious serious advice!!!

Yeah, aetna opens back up on Monday. We dont even have the new insurance cards...I just have my policy number. Im upset, but dont really want to postpone this. Im stressed about the surgery as it is..but to postpone this stress through my summer..no way! My husbands boss told us to go ahead and do it and my doctors office said it will most likely be covered..so what else do I do? I dont wnat to go to a whole new Dr and waste more time.

aliciahelene Posted: Jun 05, 2004 01:32 PM

Re: I need some serious serious advice!!!

Yeah..we found out about the insurnace switch last night..there was a letter in my husbands pay....he never signed anything. He said he was aware that they would be switching, but didnt know it was going to happen so soon. He honestly didnt know much about it! Its F&^Ucked up!!!

janwinterbridejoy Posted: Jun 05, 2004 02:59 PM

Re: I need some serious serious advice!!!

i dont think i would postpone if your already stessed about the surgery i think it would just build up for stress and make you even more nervous about. if you went for pre surgery testing then your old insurance is aware that you are getting this surgery and most likely will cover it. you can always fight it if they dont cover it and i have known plenty of people that have won and had good results with fighting the insurance companies. i hope all works out and the surgery goes smoothly

gertyrae Posted: Jun 05, 2004 04:27 PM

Re: I need some serious serious advice!!!

I just wanted to add that my prayers are with you. I really wish you luck, don't worry too much, it will work out. As other's have said, it's preexisting so one of the insurance companies will pay. My girlfriend worked for an ob-gyn for years and she said it happened fairly frequently(I called to ask her). And make sure you take it easy after, I was at Stage 3 (if I remember correctly) and the doctor told me to make sure I stayed off my feet for three days. Don't try to do stuff right away. You'll feel almost fine the next day and want to go back to regular stuff. Just relax. Good luck!!!

september2004 Posted: Jun 05, 2004 05:07 PM

Re: I need some serious serious advice!!!

health is #1, so if it something that can't and/or shouldn't be postponed, have the surgery and go after the individual companies afterwards (a PITA, but if what they did was illegal, someone will be forced to pay once you threaten to sue).

just make sure it is not somehow an oversight of your DH. as long as he didn't sign anything, he should be in the clear, but just double check what he initially signed when he accepted the job and associated benefits. paying out of pocket for a non-emergency procedure would not be cool if it came down to it...

aliciahelene Posted: Jun 05, 2004 08:09 PM

Re: I need some serious serious advice!!!

Thanks guys! And thanks gertyrae for calling your friend! I am just going to get it over with and put my faith in these crappy insurance companies. I went in for presurgery testing on Thursday..and it turns out I wasnt even covered by who I thought I was covered by. Im holding onto the letter my Dh got from his job, the one that tells AFTER our insurance was swticthed..thats gotta stand for something, right? His boss told us to go ahead as planned and it will be worked out, what that means I dont know exactly, but between him and my Doctors office trying to get a continuation or whatever with my proior insurance..hopefully this will all be fine. Im experienecing anxiety as it is with this stupid surgery..I feel like if I prolong it..Ill really freak out! This isnt my fault..so Im just going to get it done! Thanks so much for all of yoru nice words. Its nice to know such nice caring people are on here!!!