Woman Thought Her Surgery Was Preapproved, It Wasn’t

By Consumers for Quality Care, on June 23, 2017

Woman Thought Her Surgery Was Preapproved, It Wasn’t

A Utah insurance company, Select Health, has come under scrutiny for refusing to pay for a surgery after preapproving the procedure, KUTV reports.

Kristine LaMay submitted a pre-approval for her knee-replacement surgery. After she gained approval from her insurance company, she received the surgery.

Now, the insurance company is saying it won’t pay.

[N]early a year after the procedure, Select Health says they are not going to pay.

“They’re saying that the surgery was experimental,” LaMay said.

LaMay was frustrated when she got the letter, denying her coverage for the surgery.

“I followed all the rules and they aren’t doing what they said they’d do,” she said. “I would never have had this surgery if they denied it. I had the surgery because they pre-approved it.”

Even after an appeal, Select Health is refusing to fully cover the surgery.

Select Health agreed to pay about half, but that’s it. LaMay is on her own for the rest, approximately $10,000, she said.

The Utah Department of Insurance suggests that LaMay files a complaint with their offices, so they can investigate the incident.

In the meantime, LaMay is out a whole lot of money and says she now has a shaken faith in an insurance company with which she’s never had a problem before.