BCBS approval then denial

[wolfylove 25]

I have BCBS when I first asked if they covered weight loss surgery they said no. Then after I met with my surgeon and then the financial person they ran my insurance and said it was approved they got a approval number. Then 3 weeks before surgery I got a phone call from the financial person at the hospital saying BCBS said they make a mistake and my surgery was not covered. Of course I panicked for an hour and then decided I was still going threw with the surgery. I had to pay $12,000 out of pocket I am 2 weeks post op am glad I did the surgery but pissed off at the insurance company. We will write a letter to the insurance company but I doubt it will go any where. For those that there insurance company paid good for you. For those of you who it will not I personally think the surgery is worth it . I thought about this surgery for the last 12 years thought about gastric bypass but was not a candidate. Then last year heard about gastric sleeve and was a candidate. My surgeon was awesome. I live in florida on the east coast and went 3 hrs away to the west coast for surgery. No complications. The team is very helpful.

My surgeon was Dr. Erica Podolski.

[AvaFern 3,516]

I also live in Florida and I also paid out of pocket. I don't think my insurance covered the surgery, but I didn't want to jump through all of the hoops first. Mine was almost $18k though, but I also still think it was entirely worth it to just pay for it on my own. I'm almost 3-years post-op, and pretty much everyday I am thankful that I was in a position where I could have the surgery. I think you made the right call- good luck in the journey!

[chycky 671]

Get all documentation that you can. It doesn't sound right but you need the documents on the denial from company, anything you can get from doc on earlier approval and then follow their rules for the appeal. Maybe you can at least get all followup care covered.

[trekker954 421]

Did you actually get the letter that BCBS sends out to YOU stating that they approved your surgery? If so, then I would file some type of appeal. If not, then I think your surgeons office may have pulled some shenanigans knowing you would go through with the surgery and they would get their pay check anyway.

I was originally approved for a January surgery, per my surgeons financial person AND I also received a letter from BCBS stating exactly what I was having done and that they would be covering it. Then some of my test delayed the date and I had work conflicts for a few months. In June I contacted my surgeon to say my work scheduled would be finished in August and they had to resubmit the insurance request. BCBS had some questions for me, thankfully I answered correctly, and they approved the August surgery. I again, received a letter stating I was approved. So I know BCBS sends out these letters.

[chycky 671]

Whether they sent you letter or not you can possibly appeal for coverage, especially if you were at a network facility.

[Buffy1 25]

The doctors office should have filed an appeal.

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