Question:
How do you deal with this insurance denial POST OP?
I was approved and had the surgery October 31, 2002. Now they have decided to deny the claim. I am so glad I had the surgery but this is really a blow. My doctors office isn't really helping they say they just do pre-certification but the denial is based on information they sent to BCBS. thanks Sandi — Sandi O. (posted on March 25, 2003)
March 25, 2003
Sounds like a glitch. Do you have an approval letter? Call BCBS and tell
them they approved you and must adhere. I wouldn't worry about it. I'd
let your surgeon bill them as usual and let them deal with it.
— Kimberly L.
March 25, 2003
You need to call the folks at BCBS and find out what happened. I got an
approval letter prior to surgery, and they paid for all the bills but one,
which kept getting bounced back with a notation about how they don't pay
for obesity surgery (mistake!). It took several calls to get it
straightened out -- BCBS kept saying the doctor had used the wrong
diagnostic code on the paperwork to get paid. Finally it got fixed. Your
problem may be that simple. If it isn't, ask BCBS why they first approved
it, and then denied it (IF that's what happened).
— Suzy C.
March 25, 2003
BCBS should have sent you a letter indicating that the surgery is covered
as part of your policy, however that doesn't guarantee how much they will
pay. You should have also gotten a denial letter indicating exactly what
the problem is. It is either that the pre-auth was not entered into your
file as approved or that the surgeon has billed a procedure code that is
incorrect. In addition they have billed with a diagnosis code of obesity
instead of morbid obesity. I'm sure you can get this straightened out but
it will likely take time, but don't give up. This is one fight definitely
worth taking on as there is a lot of money involved and it sounds like you
are entitled to have this covered to some degree as part of your policy.
— zoedogcbr
March 26, 2003
I also have BCBS and they sent denials for the hospital bill, surgeon's
bill and anesteologist's bill. I called on each one when the denial was
received and each one ended up being paid. One had a wrong code, another
had something to do with a computer glitch, etc., etc. I find that BCBS is
very quick to deny without verifying errors by them, the doc or the
patient. They just deny and then probably wait and hope you don't call to
correct it. I have found though that more than 50% can be corrected and
then paid if you just call. Resubmission and/or appeal not needed. Just
call first and find out what the problem is on each bill.
— jutymo
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