What a Crock!

[mattie7632 24]

BCBS stated I must have a psyche eval, dietician eval and medical eval as requirements to authorize lapband surgery. So I did as instructed, and a month later what do I get in the mail? BCBS DENIES the psyche eval as "no authorization obtained!" Then they wouldn't give me the auth because it would be retroactive! Wow, that's serious BS! Also, the EOB said "I'm not repsonsible because the preferred doctor did not get auth and should have known" so I called BCBS and while on the phone the rep apparently changed her mind and decided that "It is my responsibility" . I've had BCBS Fed for 9 years and never a problem, but now I'm ticked! I'm gonna pay the doctor anyway, just because it's just not right. A$$holes.

[Rainydayz 3]

Wow. That sucks! But are they still going to accept the psych eval. as valid toward the pre-req. for surgery? If they don't they would suck big time. Which is why I'm going to my PCP this Friday and getting a referral for the nutritionist, psych. and bariatric surgeon. Gosh, insurance bites.

[Grider 92]

Wow. That sucks! But are they still going to accept the psych eval. as valid toward the pre-req. for surgery? If they don't they would suck big time. Which is why I'm going to my PCP this Friday and getting a referral for the nutritionist, psych. and bariatric surgeon. Gosh, insurance bites.

If i am reading correctly you are getting referrals? i was told 5 times, if a DR is on the providers list -no referral is needed. I am just starting here, and thought the surgeon sets all those folks up?? one thing is for sure, i will make sure all these drs etc are linked somehow. what a mess, makes you wanna eat a whole pie! I also saw dieticians are NOT covered if they are not diabetes sessions?

they make it hard dont they?

[Hydun2 0]

It is the responibility of the doctor to request the authorization. If they fail to do this and see you anyway the claim will be denied and it will have to be written off by the doctor per their contract with BCBS. I'm not sure as to why they are now putting it in your responsibility, they shouldn't. I would call the physician's office to see if they have appealed the matter with BCBS.

[Rainydayz 3]

OK, I don't know about BCBS. I have Aetna. And I have since found out that I don't need a referral for a specialist. But what I was talking about was I going to ask my PCP to write referrals for all the other doctors just in case I needed them. I don't know how BCBS works. But I would certainly be checking before hand because I know insurance, no matter which one it is, tries to get out of paying everything they can and if they can. Better safe than sorry right?

[Rainydayz 3]

one thing is for sure, i will make sure all these drs etc are linked somehow. what a mess, makes you wanna eat a whole pie! I also saw dieticians are NOT covered if they are not diabetes sessions?

they make it hard dont they?

I would be careful also about using all the specialists that the surgeon's office recommends, UNLESS they are all in the same office. I had one surgeon recommend a separate psych to me and I made the appointment and after i was in there with her she told me that I would have to come back 3 MORE times at $200 each time in order to get a clearance for bariatric surgery. I found a psych on my own that charged $175 for one visit of 45 minutes and got my letter when I walked out. So just be careful.

[Acadia 20]

With BCBS it is the subscriber's responsibility to get the preauthorization. NOT the doctor. Especially for mental health / behavioral health care.

The preauthorization process is there for a reason - if your company has an EAP program then your psychological counseling could be covered - at no charge. This is especially helpful since most counseling requires 3 or more sessions before they'll write the report (which isn't covered by BCBS and usually costs $150-250). This also allows you to have counseling leading up to and after surgery, which is very helpful for a lot of people.

Your Dr's only responsibility is to bill your insurance or complete the EAP form. Not to get preauthorization - any office that does that is doing so as a courtesy. They don't have to do it.