Anyone heard of insurance not paying for. . .

[StLouisGal 1]

I just got a letter from my insurance company (Anthem Blue Cross/Blue Shield) saying they don't cover anesthesia. What the ???? How can they do that. The explanation is that this isn't a covered charge. Anyone experience anything similar?

[Wheetsin 714]

I had to fight to get the larger part of my anesthesia covered. Not because of a denial tho, in my case it was a billing fiasco. I have heard of people who have had certain parts of their procedures, including anesthesia, denied. It may be that the type of anesthesia goes beyond their definition of "reasonable and customary" (in which case you would pay the difference). It could also be that the anesthesiologist is not a networked provider. Because a facility is in noetwork doesn't mean all its employees are. Definitely follow-up with them for more information... find out EXACTLY what about it isn't covered.

[StLouisGal 1]

It says it is a network provider, just that it isn't a covered charge. I hope it is only because the bill for the anesthesia hit before the bill for the surgery. I'm totally confused. I plan to call the surgeons office tomorrow to see if they have any ideas and call Anthem if I have to. It is so frustrating. I had to fight to get it approved and now they seem to have forgotten they approved it.

[Wheetsin 714]

There are sometimes confusions between anesthesia, anesthesiologists and nurse anesthetists. I'd definitely call and ask them why anesthesia is not covered. At least it's usually a reasonable amount compared to the hospital bill.

[StLouisGal 1]

I called the insurance company this morning. They said that Obesity is an exclusion for my policy and the computer automatically kicks it out. Since I was pre-approved for the surgery they will manually process it and pay the bill. Whew!!! I was worried there for a minute. They also denied the first followup appointment for the same reason so when that statement comes I'll have to call the doctors office and have them send more information, although I was sure the doctors office said they didn't charge for the first three months of aftercare so I am not sure why they billed my insurance company for that anyway, very curious. They did pay all by my $500 copay on the hospitals bill so that is wonderful. Thanks Wheetsin for the support.