Important Question....Need Your Help

Hi everyone....I was approved and given an approval number by Independence Blue Cross/Blue Shield for WLS on January 18, 2005. My doctor could not do it in December because of his schedule. Last week I was informed by BC/BS that my plan will not cover this surgery effective January 1, 2005. When questioning them why I was approved two months ago and now will not cover it, their response was that this was an approval and does not guarantee payment. It just doesn't make sense. I feel they have jerked me around. Has anyone have had this problem? Also, does anyone have any idea what I should do now. I have a filed a complaint with the State of Georgia Insurance Commissioner's office. I just hope they can help me. Thanks for you advice.

My approval letter said the same thing - that an approval does not guarantee payment. It's different for me since I've already had my surgery - but I'd think since they already gave you an approval it should be okay. I'd call a supervisor at BC/BS and confirm though. Good luck!

I would call the comissioners office again and ask and call the BCBS on your card too and have them explain in detail. I agree with Dee Dee, it seems like it should be okay, but you never know. You are in my thoughts and prayers. Hugs, Debra =^..^=

I have BC/BS GA PPO. When I was approved, the approval code was good for 1 year from the date of issuance. This should be the case with your carrier too. Yes, they may have stopped covering the procedure, but you were granted an approval before the coverage was stopped. They will have to cover your surgery.

I'm so sorry you're running in to this! I just started the process in mid-November and was told then by BCBS that it would not be covered in 2005. So I rushed, and had the medical, pulmonology, cardiology and psychology testing/clearances done in 3 weeks. Then BCBS took 2 1/2 weeks to approve me, leaving me only 1 week to get surgery scheduled. By then there were no ORs available in December at the hospital my surgeon uses. Fortunately, I found out two things: the bulletin BCBS sent out to providers in October said that for companies whose coverage was ALREADY RENEWED (in October) for 2005, it would still be covered; but for others, it would not be. Then I checked with the head of our benefits department and found out that our firm specifically negotiated to keep IN the benefit for bariatric surgery. Don't give up! Keep checking. And don't talk with just anyone at BCBS. Be sure to check with a supervisor, and check with your benefits department at work... they may have good news for you.