Momof2boys

So I have BCBS of AL.. went through pre-approval.. all is good.. get approved on July 15th.. Surg was Sept 21st... I got my EOB in.. Insurance paid everything (anesthesiologist, xrays, all misc bills from surg) EXCEPT the surgeon ($2,300) and the hospital ($21,132)!!! thats all! OMG

Call hospital, they tell me its not thier problem.. call BCBS they tell me that they do not cover anything related to "obesity", which is the diagnosis code dr used... (UM WHY ELSE DO U HAVE THIS SURG???)

So I call dr.. they say they will have it all resubmitted..but they always use 'obesity' when they do the surgery, but a diff code when the get the surgery 'preapproved'...

How does an insurance company APPROVE this ....then AFTER you have it deny it????



I am fumming mad..it has been resubmitted..so in the meantime (4-6 wks) i have to sit and stress over almost $25,000 worth of medical bills!?

Guess its thier problem... u cant take what I dont have

UGH... At least I got the surg! .......... damn insurance ppl...

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HEAVIEST (Pre-Liquid Diet prep)/CURRENT/ 1ST GOAL
398/349/200

JULY 15TH - SURGERY APPROVED


SEPTEMBER 21, 2009 - My 2nd Birthday- Lap RYN!

Vetty

presbyterian my insurance doesnt cover bariatric surgery for people who are "just" obese. I had to prove that I had a co-morbid condition. I am still in the process of doing it! I cant believe they are barely telling you this!

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VETTY


I am sick of being the president of the Pretty face club!!

10/2/2009 Called to ask insurance what’s the "new" process
10/8/2009 Case Manager was assigned
10/13/2009 Medical director agreed to accept my medical evaluation from the first time I tried for bariatric surgery
10/14/2009 Case Manager and orthopedic doc. Proved I had a co-morbid condition
10/23/2009 Quit Smoking
11/14/2009 WLS Seminar

Jeanie

Make sure you keep the pre-approval letter, so that if you need to fight this you have that. They approved the surgery therefore they should pay for it. maybe the doc office used a diff code for pre-approval and they use that code to resubmit the bill. Good luck I hope they pull their heads outta their butts!

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Lap Dr. Callery
July 7, 2004
Savanna Annmarie was born on 10/14/2008

poet_kelly

I assume you have a letter or something in writing saying they approved the surgery? Make sure the surgeon's office is using the same code now that they are submitting for payment that they used when they submitted for approval. As long as they do that, I don't think you'll have a problem, as long as you have something in writing saying it was approved.

Kelly

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RNY 11/4/08

surgery/current/goal
270/147/130

Josephine

That is crazy!!! I'll pray for you!!

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Momof2boys

Pray for them to..because after I have a mental breakdown.. Im gonna be after someone

And yes.. the doctor's office has the letter of preapproval in my file.. I double checked! (If they sent me one, I dont remember, its in my mail pile LOL.. )

But I wont roll over on this! I was just wondering if I'm the only one... surly not...I need a light at the end of the tunnel..before i have a meltdown over this.. $25K! Ya ok! Ill just write a check..

__________________
HEAVIEST (Pre-Liquid Diet prep)/CURRENT/ 1ST GOAL
398/349/200

JULY 15TH - SURGERY APPROVED


SEPTEMBER 21, 2009 - My 2nd Birthday- Lap RYN!

poet_kelly

I got a couple bills after my surgery for stuff that should have been covered by insurance. I just sent them back to whoever sent them and said, bill my insurance, please. They did and insurance paid for them. I know that's not the same thing that's happening to you, your insurance is saying they won't pay. But I think they will. I would try not to get too worked up about it yet.

Kelly

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RNY 11/4/08

surgery/current/goal
270/147/130

adagirl

I know it is hard, but try not to stress. Its a problem w/the code I'm sure. Its very important that the correct code is used or it won't go through. I'm not sure why they say they always use a different code for pre-approval vs. billing. That makes no sense at all to me. But, rest assured, as soon as the code is corrected, they will pay. Medical insurance billing is just sooooo messed up because not only is the process confusing, but most of it is farmed out to workers overseas. So, its someone in India or China who is actually processing the billing because its cheaper for the insurance companies to do it that way. But, a lot of stuff gets lost in translation. Or, these workers give canned/pre-written responses that don't make any sense at all. It drove me absolutely nuts when I was trying to work through a bunch of billing mistakes that were made for my daughter's birth. It got to the point where if the mistake was less than $100, we just paid it. We literally had about 20 different billing errors... everything from the weekly stress tests I had done in the hospital to the surgeon's assistant not being paid. And, being charged for miscelaneous crap in the hospital like maxi pads.

Momof2boys

Adagirl - Thank you! You have made me feel better! Even though I know I dont have the $25k... they can make life hell on you. I just wasnt ready to gear up for this battle. Thank you so much!

I love my TT ppl!!

__________________
HEAVIEST (Pre-Liquid Diet prep)/CURRENT/ 1ST GOAL
398/349/200

JULY 15TH - SURGERY APPROVED


SEPTEMBER 21, 2009 - My 2nd Birthday- Lap RYN!

narf852

Same thing happened with my husband (not wls but another surgery) He was told to go to the hospital financial "person". What they did was "dismiss" the 3,000 plus that was owed (everything else was paid) They wrote it off as they would a "hardship" case. Don't worry the hospital will get their money from another organization that deals with "hardship" cases. They were very nice. Hope this helps!!!!!!!!!!!!