LynnOregon

Has anyone ever had this happen? I was approved for surgery; my surgeon is in network, etc. My surgery was last March. BCBS paid for the hospital, the anesthesiologist, and the upper GI. I spoke with BCBS every step of the way to make sure of coverage. I recently received a statement from BCBS saying that my surgeon is not covered. How could this be? I am so confused.:confused2: Thanks.

We had to get my husband's self insured company involved. Once the HR manager spoke to BCBS, they paid the claim. I am not sure why coverage of the surgeon was denied after approval.... but as I said, the woman in billing said that BCBS is notorious for this. The other thing hard to believe is that someone without insurance coverage would have to pay $8,300. for the surgeon when BCBS only pays the surgeon $2800. This seems so unfair that ordinary people have to pay so much more because they do not have the negotiating power that BCBS has.

Just a quick update: I spoke with hospital where I had my surgery today and the woman in billing told me that BCBS was notorious for excluding coverage for the surgeon after approval for surgery. She said that it usually takes months of appeals for them to finally cover the surgeon. So much for dotting all the I's and crossing the T's prior to surgery. Just because your surgery is approved verbally and in writing with BCBS, doesn't mean that you will not be appealing for coverage apparently. I am going to stay positive and think speedy resolution!

Thanks for your feedback. Because my husband's company is self insured, we are going to request their help. What is so confusing is that we sent in all the documentation BCBS asked us to. They sent an approval letter to both my surgeon and me. I spoke with a representative from BCBS right before my surgery too. We discussed everything and she said, "Have a good surgery." The rejection of the claim states the service/expense is not covered under our plan. This does not make sense because it is covered and my surgery was approved as medically necessary. My BMI was fluctuating between 38 and 39 at the time of surgery, although it was 40 when I started my most recent weight loss program. We submitted all co-morbid conditions. I had at least four. This is all so frustrating. The surgeon's bill is over $8,000. I don't understand why BCBS won't cover my surgeon! Hopefully, I will have answers soon and I will post them to the forum so that others will be aware of this possibility. Thanks again

My surgery was approved and I was banded on March 31, 2008. So far the insurance company has paid for the anesthesiologist, but not for the surgeon or the hospital. The bill was sent to them quite some time ago. I contacted BCBS and they said the claim was being “processed.” Has anyone had an insurance company approve lap band surgery and then later decide not to cover it? :confused2: I am getting concerned because the hospital said that it usually does not take this long for an insurance company to pay once they send the claim in. Since the surgery, they have only paid for the upper GI and not the fills yet. Thanks.

Hi All, My surgery was on 3/28/08 and I feel so weak. How long before all of you regained your energy? I am consuming about 800 calories a day now of high Protein liquids. Thanks, Lynn Banded on 3/28/08 Portland, Oregon Dr. Jan

I've lost 7 pounds!