Insurance nightmare BCBS OK

[bunyip 27]

I posted here before about my insurance company dragging its feet and taking three weeks to approve my surgery last December. They managed to drag it out long enough that I couldn't get the surgery done until after the first of the year, but they DID approve it. So I had my surgery on 1/20/16. Now they are refusing to pay ANYTHING. Yep, they have denied all claims, saying that my surgery is not a covered procedure. WTF???? I requested an appeal and got the same answer. The doctor's office called them today, and they said that my coverage changed on 1/1/16 and the surgery is not longer covered. Like they didn't know that was going to happen when they approved it? I'm so angry now I'm having trouble even typing this. Now I'm supposed to be clairvoyant and know what changes are coming. They NEVER advised me of any such changes. It's probably a good thing that their office is in another city about 80 miles from here.

How can crap like this be legal? They had nearly three weeks after the supposed change in my coverage to contact me or the doctor's office and notify us of the change. They did nothing. So now I'm getting bills amounting to roughly $82,000. Maybe I can just sell my house and live in my car for a while.

Edited March 8, 2016 by bunyip

[Cervidae 2,389]

Oh my goodness... this is so awful! I know absolutely nothing about possible things you could do from here, hopefully someone will have some suggestions, but jeeze... this is just terrible. I'm so sorry this crap is happening to you.

[atlmag 77]

When did they approve it, before 1/1/16?

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[bunyip 27]

They approved it last in Dec 2015. Late enough that I had to wait until January to get it done. If they'd done what they were supposed to do and hadn't given me the runaround, insurance would have covered %100 because I'd already paid all my deductible and out of pocket expenses.

And now this.

If they think I'm going to give up and go away, they'd better think again.

[atlmag 77]

Definitely a nightmare, get a copy of approval and see what it says maybe even have an attorney look at it.

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[bunyip 27]

I've got a copy and sent it to my employer's insurance people. They checked and advised that there have been no changes to our plan this year. Interesting ain't it? Both that office and my surgeon's insurance people and patient advocate are also working on this. Next stop, if necessary, may be the state insurance commission, although I hope it doesn't have to go that far.

[UsernameTaken 283]

Wow sorry you are going through this. It's horrible:( BCBS of what?

[bunyip 27]

BCBS of Oklahoma. They have done nothing but give me the runaround and drag their feet since the beginning of this. I'm just wondering how many other people they've done this to who have just given up trying to get them to do what they're supposed to do.

[UsernameTaken 283]

Yeah sounds like some legal action needs to take place with these people.

[pammieanne 269]

Oh no, that stinks! I have a friend with BCBS OK, and they were told, last year I believe, that WLS was not covered... but I would imagine there are several different plans, and if you have an approval from late December, I don't see how they can back out now!

By the way, I live in OK too, just north of OKC proper... I'm having surgery soon, I hope, down in Norman (my friend is a bariatric nurse down there, so I chose that hospital). I think you're the first person I've seen on here from OK, so I just wanted to say hello!

[flesteresq 63]

You might need to sue for breach of contract.

[McNaughty 16]

OKC here. BCBS FED covers it. I guess there are drastic differences in the FED and OK plan.

[bunyip 27]

Update:

I got my second bill from my anesthesiologist for the full amount of his services. Yeah, big surprise. I called my surgeon's office and my employee benefits office, and neither of the had heard anything back on their inquiries. So, I called my insurance company back yesterday, ready to do battle again, and was told by the insurance rep that my hospital bill had been processed and that the payment should go through any day. She called me back later and said the doctors' bills had all been reviewed and passed on for payment also. Her excuse for the refusal and delay in payment was that "those codes can be so confusing". Yeah, their codes that they use every day confused them. Heaven help us all.

I'm trying to be cautiously optimistic about this, but I'll believe this nightmare is over when I hear it from all the doctors and hospital and when I get my insurance statements showing the payments.

[dadsrebel 24]

That's good!!!!! I had a similar problem with BCBS. They approved my surgery, I did all my pre-op requirements and get came back and denied. I had to change insurance companies to get my surgery approved

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[GibbsGirl 483]

Oh my gosh this is insane ! I hope they get it all adjusted and paid for you.

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