I Was Preapproved And Now After Gastric Sleeve Surgery Insurance Is Denying Claim. Beware!

[Norman 1]

Anthem BCBS pre approved me for surgery. I had my surgery in July and now they deny the surgeons bill, the hospital bill and the anesthesiolists bill. I call and they say we will send it back over in the mean time I am on the verge of going to collections. BUYER BEWARE. Insurance companies suck.

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[thinoneday 445]

Wow that really does suck. . . i don't even know what to say except i'm so sorry this is happening to you. Do you still have the letter that says you were preapproved? Can't you fight with that? Wow, I'd look at getting a lawyer.

[Norman 1]

I have every expectation that they pay in time. I hope. They said they would in the preapproval letter. I think this is just a common way insurance companies handle their business. They want to avoid paying for as long as possible. The problem is what will this do to my credit?

[kellyw74 258]

They usually will deny what they bill because the dr's want to charge $500 for something and the inusrance only will pay $280. They have negotiated pricing on everything and will not pay above that.

Insurance companies DO suck!! I work for one. However, re-submit it and send a copy of your pre-approval letter.

Kelly

[uromanager72 0]

Hi Norman!! Im really sorry about your insurance situation. Please let me know what happens. I have Anthem also and have been preapproved. Wow that is like exactly what you didnt need after surgery. You are trying to enjoy your new life and BOOM this happens. I will pray for you. Keep me informed,

Sarah

Anthem BCBS pre approved me for surgery. I had my surgery in July and now they deny the surgeons bill, the hospital bill and the anesthesiolists bill. I call and they say we will send it back over in the mean time I am on the verge of going to collections. BUYER BEWARE. Insurance companies suck.

[Norman 1]

yes it is amazing how much less insurance pays then what is billed. I just have to keep calling. For some reason Anthem likes to lose things a lot. I think they like to delay paying their bills.

My dad has Anthem too and he said he had threaten them with a lawyers letter to get them to pay a Quest bill. Quest had sent it to collections becasue Anthem took soo long. They deny then say they lost it then deny then lost it finally after lawyer letter they took care of it.

[SittingPretty 16]

I hope you can get this worked out. I just looked at my approval letter from Anthem CA and it only states that the approval is based on medical necessity and is not a guarantee that benefits will be paid if I am not enrolled and eligible for benefits of the date of service. Keep us updated.

[Norman 1]

Yeah that is what they are saying that it was not medically necessary. They claim to not have the pre approval letter as well. much fun. I belive this will eventually be paid however they want to make me work for it.

[RSREED53 4]

I would get my approval letter from the ins copied and sent to each of the parties needing payment. In the meantime, get a lawyer to go to bat because that sounds fishy--it is breach of contract to not pay for services once the ins co. OKs it.

Good luck!

Anthem BCBS pre approved me for surgery. I had my surgery in July and now they deny the surgeons bill, the hospital bill and the anesthesiolists bill. I call and they say we will send it back over in the mean time I am on the verge of going to collections. BUYER BEWARE. Insurance companies suck.

[KMP85 11]

Dont get me started on Anthem BCBS. I am with them as well, good insurance but they do suck. All my pre op testing was covered, I am all set to set a surgical date and then I was then told it wasnt no longer in my contract. I HATE INSURANCE COMPANIES!

Anthem BCBS pre approved me for surgery. I had my surgery in July and now they deny the surgeons bill, the hospital bill and the anesthesiolists bill. I call and they say we will send it back over in the mean time I am on the verge of going to collections. BUYER BEWARE. Insurance companies suck.

[RSREED53 4]

Contact your state dept of insurance to complain about treatment of coverage. If they no longer cover the surgery, then that is fault of your employer. HOWEVER, I would send all documents of approval to the Insurance Commission--the carriers usually HATE to be investigated by the State! Worth a try. I would not give up the ship with them. Hang tough! Ronda

Dont get me started on Anthem BCBS. I am with them as well, good insurance but they do suck. All my pre op testing was covered, I am all set to set a surgical date and then I was then told it wasnt no longer in my contract. I HATE INSURANCE COMPANIES!

[Tai29 17]

Working for a hospital that is also a premier bariatrice center of excellence, I see this all the time. BCBS is a main offender. As the patient, I will reccomend that you stay on top of them because they quite frequently say they will reprocess something and it will go into the Anthem black hole and when you follow up you will learn they really have done nothing with the claim. Also, I would suggest finding out WHY they denied the claim. It is also important to note, the pre-approval is not a guarantee of payment. The insurance company determines payment eligibility upon receipt of claim, and surgery notes, etc. They are under no obligation to pay for your medical services because you received a preapproval letter. Frequently we will receive precertification for inpatient hospital stays, only to have them denied once we submit the claim. We end up going through appeals processes to overturn their original denials. Insurance companies are very ambiguous in their wording so that if they do decide to deny something, they can site the technicality in the letters to you that will allow them to not do so. Also, what someone else said is true too - your benefits are ultimately determined by your group (employer). Companies buy insurance packages that are one size fits all, and they in turn distrubute them to their employees. The company you work for determines what they would like included in the benefits package and sometimes costly procedures are nixed for budget purposes.

[sweety93 18]

It's really very simple.....call your members service and advice the surgery was pre approved and request that your claims are adjusted while you hold the line and all should be well.

[Tai29 17]

It's really very simple.....call your members service and advice the surgery was pre approved and request that your claims are adjusted while you hold the line and all should be well.

It's really not that simple. In the grand scheme of things a preapproval does not mean anything. It only means that your insurance company has reviewed the guidelines for which a person can have that surgery, and the diagnosis codes, etc that your surgeon's office submitted to them are all in line with industry standards for that surgery. There are a million things that can happen once they recieve the claim which will disqualify payment. The most popular being the employer group no longer wants to cover this type of procedure for it's enrollee's. It may be a popular procedure, and the costs the company (employer) are incurring are more than what they want to pay, so they remove it from their list of covered services. A pre-approval is not a guarantee of payment and that verbage in some way or another is actually on your pre-approval letter. If it were this simple, I'm sure he would have done this already - and actually I do recall reading near the beginning of the thread where he did call, and was told they would reprocess and that got him nowhere. The best thing to do in this case is go to HR. If it's not covered anymore, and this is insurance through his work - their benefits office would determine what services are covered or not. I actually had a company pay their members surgery costs last week because the same thing happened to a patient who received surgery at our hospital. Most employer's are not this willing to ammend their mistakes like this though.

[sweety93 18]

Yes I agree but first things first, before fearing the worst, try the simple approach.