Denial

Okay - I posted earlier about my doc's office calling and leaving me a message and me getting voice mail when I called back. Well, I finally talked to somebody and am a little upset about this process. I need to vent........ Today I was told, by my doc's office that I have been denied for surgery. Devastating!! Then I find out that they submitted to my husband's insurance company (Anthem BCBS) not to mine (Sloan's Lake) because they were under the impression that BCBS was my primary carrier. So, that's good and bad news I guess. First the good - I have another chance to be approved by my company. Secondly the bad, time has been wasted on submitting to the wrong company in the first place. Let me explain my frustration. When I was at my consultation Patrice, RN, told us that BCBS was not paying for surgery except for maybe $1500 because my surgeon doesn't operate in one of their 'approved' facilities and that we would be better off to submit to Sloan's Lake. So here I thought all this time that is what they had done. Not the case. I don't understand why they submitted to them knowing ahead of time the way they do things and knowing I had other insurance. I'm a little frustrated with the time wasted. One other good thing though - my husband's company HR person has said that he is going to write an appeal on my behalf to the insurance. He stated that if the surgery is considered medically necessary that they need to cover it. So that's good too. Okay - I vented and feel better. Thanks to all of you that are out there pulling for me. It really helps to know the support is there. I'll keep my fingers crossed for the next submission and see where that goes. Thanks ~ Kelly Is it normal to request what was submitted by your doc when you file an appeal?

Kelly, I sure hope your Dr's office does what they can with BCBS as far as your approval goes. I have not heard of a "reconsideration", just appeals. I sent thru 2 appeals, and with the help of an attorney, won the 2nd level. Hopefully you won't need to go that far into it, but if you do, please let me know and I will give you his information. It cost me $450 (but SOOOOOOOOOOOOOOOOO well worth it!!) Please keep us posted on your insurance progress Hugs, Susan