NOT Approved...HELP!!!!
Ok folks. So I have competed EVERYTHING that I needed to do for surgery. On Aug 8, my doctor tried to submit to BCBS AL for a predetermination and....they denied it!!! Even though they have it on record that they TOLD ME that the surgery is covered (back in January) AND on my job's BCBS website online coverage book it says that it is covered if 'medically necessary'. NOW they want to come and say to me that 'my employer does not cover it'. I have spent so much time and money on this. One department is not returning phone calls and another supervisor has said that if I fax in my receipts that they will reimburse me for my doctor's expenses. BUT I put a salaried job on hold for 4 months, so technically they OWE ME a couple of thousand dollars. In addition, all they have to say is 'oh, if you had the surgery already we would pay since its our mistake, but since you haven't, we won't. Sorry for the inconvenience.' I am traumatized and do not know what to do. Has anyone had to go through this or had to do some appeals????? HELP ME PLEASE!! I am at my wit's end!!!
I work for East Alabama Medical Center. I just found out today that they pay for the gb if you have the PMD insurance, but I have POS which is the one that requires a referral. Guess who went to their employer today to switch to PMD? LOL. I have outsmarted them. In about a week I will have my new group and contract number and my surgeon will refile and I should get approved instantly. Yay me!!!,
Hi there. I'm Nicole. I took special interest in your post b/c my surgeon will be submitting my paperwork for approval next week. If all goes well, I'm supposed to be given a date for the end of September, possibly early October.
I am sure you were quite devistated to hear that you were deniedto get denied as I would as well. Well, as you said, you outsmarted them. Great move on switching to PMD. Your actually lucky. We're only allowed changes during a certain time of the year and even if a change is made, they don't go into effect until the 1st of the following year.
I will keep you in my prayers. Hopefully all will go well.
I am sure you were quite devistated to hear that you were deniedto get denied as I would as well. Well, as you said, you outsmarted them. Great move on switching to PMD. Your actually lucky. We're only allowed changes during a certain time of the year and even if a change is made, they don't go into effect until the 1st of the following year.
I will keep you in my prayers. Hopefully all will go well.
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