Approved

[AZPete 20]

Hard to believe I had my patient advocate submit for my band to sleeve revision surgery today and I got a call a half hour later saying that Blue Cross/Blue Shield of AZ had already approved it! She said that it was hands down the quickest approval she has ever seen. Now I have to set a date.

[AdeptDreamer 104]

Congratulations !!!!

[ebonisekim 1,713]

Congrats

[lolarose13 147]

Hi Azpete! Do you remember/know your insurance requirements? I'm going for my consultation and I have BS of CA, but they said that since I live in Arizona and they surgery will be in Arizona, I need to follow the BCBS of AZ requirements! (?) I'm super nervous about this

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[kmorri 1,689]

Please make sure to call your Blue plan and ask them....call the phone number on your card and ask, because the information you were given is incorrect. I retired from BCBS of Florida....the way all the Blue plans work is where ever the service takes place that plan actually processes the claim.....but they process it using the "home" plan's guidelines...The home plan is the plan on your card. So in your situation....AZ will process the claim but they will process it using the CA plan's guidelines..When your AZ doctor files the claim with AZ Blue, they will communicate with the CA plan and ask them if the procedure is approved.....If CA says yes, the AZ plan pays the doctor based on his AZ Blue Cross contract...I know that sounds complicated....but it goes pretty smoothly ....but call your plan to verify. You don't want to have any surprises.

Hi Azpete! Do you remember/know your insurance requirements? I'm going for my consultation and I have BS of CA, but they said that since I live in Arizona and they surgery will be in Arizona, I need to follow the BCBS of AZ requirements! (?) I'm super nervous about this


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[lolarose13 147]

Thank you so much @@kmorri! Your explanation was perfect and it makes so much sense! I will definitely call them to verify everything. Thank you again!

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Edited March 31, 2016 by lolarose13

[kmorri 1,689]

@@lolarose13 You're very welcome! Lots of times the doctors offices are confused because to them it looks like they are only dealing with the home plan but they don't see what goes on after they file the claim......Your doctor's office will also file your approval request with the AZ plan.....but AZ will ask CA to make the determination.....that's the part the doctor's office won't see. So it was an honest mistake by your doctor's office.

The process for getting this surgery is complicated enough without having to deal with insurance surprises......Good luck to you!!! Feel free to reach out to me anytime. I'm going though this now as well my surgery should be in May but I don't have a date yet.

[betterme38 275]

Congratulations!

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