insurance question - help!

I need help finding information. My insurance company - BC/BS of CNY PPO finally sent me a check for my surgery. They are only willing to pay $1,600. - not even 20% of the bill! Their explanation is that this surgery can be had by other doctors at the same hospital where I had it done for this price. Of course they will not give me the name of any of these doctors and honestly I am unaware of any other bariatric surgeons practicing at this hospital. According to the insurance company I need to justify why they should pay more. I find it hard to believe that an open RNY and removal of my gall bladder can be done anywhere for $1,600. I've paid more than that to my dentist for a root canal. Has any one out there had this problem? Does anybody know where one can turn to find out what the going rate is for an Open RNY proceedure? I'd really appreciate any assistance or comments you might have. Thanks!

Hello Sara. My Open RNY procedure cost $37 thousand dollars. I ended up paying $200.00 of that (plus $995 for the weight program). Did you recieve an approval letter from your insurance company before the surgery? I find it odd that they would back out now - and I'm not a lawyer, but I don't think legally they can do that. I also don't think your surgeon would have proceeded with the procedure if you weren't approved by your insurance company. Maybe you should contact your surgeon's office - they would have the authorization number for your approval. That should tell the tale. I'm sorry that you're having this difficulty now. We've all been through such a life changing ordeal... this should be a time for happiness. Keep your chin up and don't worry about anything until there is something to worry about. - Jackie

Jackie - yes, I was pre-approved for the surgery. The sad thing is that it cost more to jump through all the hurdles of the approval process than Blue Cross/Blue Shield is willing to pay for the surgery they required approval for. I've also met all of my deductibles for the year so this is supposed to represent full payment.

My Open RNY procedure cost $37 thousand dollars. I ended up paying $200.00 of that (plus $995 for the weight program). Did you recieve an approval letter from your insurance company before the surgery? I find it odd that they would back out now - and I'm not a lawyer, but I don't think legally they can do that. I also don't think your surgeon would have proceeded with the procedure if you weren't approved by your insurance company. Maybe you should contact your surgeon's office - they would have the authorization number for your approval. That should tell the tale. I'm sorry that you're having this difficulty now. We've all been through such a life changing ordeal... this should be a time for happiness. Keep your chin up and don't worry about anything until there is something to worry about. - Jackie

Sorry for the double post. It took a while for my post to show.

Hi Sara, It sounds like they are giving you the "run around".. The Ins. Co. knows exactly how much this surgery costs and what it involves !! Did they tell you upfront what they would pay for benefits to have your surgery ?? Do you have an Ins. Commission in your state, maybe they can help you. They are the ones that control the industry where I live, anyway... Good luck and best wishes on being on the losing side.. Think positive !! And go "it" one day at a time, everything will work out.. God Bless, Joanne

BC/BS knows how much the surgery is. They just never miss the opportunity to jerk someone around. I had to bite someone's head off because they told me a Urinary Tract Infection was a "preexisting illness". Just get mean and they will plant both lips firmly on your a$$. Hang in there H