Insurance Shenanigans

First of all, my insurance should pay for the hiatal hernia portion of my surgery. That is covered, however, as of yesterday - it was denied because they didn't think that the code provided by my surgeon was "specific" enough. 


FFS.


So I had to get the insurance co, the billing dept from my dr, and me on a three way conference call.  The billing dept confirmed that the coding is correct and all submitted documents were received.  Then insurance co. decided they would resubmit that code and see why it was rejected, as the code is correct and the denial gave no specific reasoning for the rejection. So the wait continues, as the insurance co attempts to weasel out a real reason from the "denial dept". 


I'm going to go ahead and assume that they just flat out deny all claims the first time, for no reason other than to see who really needs the surgery. Which (as a Canadian living in the US makes me SICK).


In 2012, after my first surgery with the hiatal hernia (insurance approved) repair and VSG (self pay) , I had a year long fight with the insurance to pay the portion for their portion of the bill for the hernia repair.  They denied the claim after first approving it because.... they claimed that the reason for the hernia repair was obesity, and they don't cover weight loss surgery. *BOGGLE*


I had to basically had to start a month long calling campaign and then threaten to sue them over the cost of the hernia repair. They finally acquiesced.


The hoop jumping required by insurance is brutal.


I am a smart, organized individual and they make it very difficult.   I am fully aware that they will very likely pull the same shenanigans this time - starting with denying my right to have my hiatal hernia repaired. 


So, I will document it all carefully, and then spend the next year post surgery fighting with them, but I won't play nice from the start. I'll just go straight to the jugular.


The worst part of me, is that this is just taking a lot longer to get done than I was hoping. I was really hoping that I would have a surgery date now, and I would be able to start planning my life around that. 


But... I guess I can count on this...