HELP!!! Got my approval Letter from BCBS..update.....

Okay so today I got my letter from BCBS....BUT this is what it says:::

"We have determined tat Laparoscopy provided by an MD in an outpatient setting is elligible for benefits under the member's health care plan...blah blah blah"

What does this mean?????  This isn't outpatient and it doesn't say a word about RYN????

Help!

All is well.  Since I dont have an actual date for surgery yet, they just put outpatient.  When I have a date, either I call them or the surgeon's office does and then they put the actual dates down and it's covered for 2-3 days.  thank goodness.  Geesh, what a letter to come home too!  lol

Monica, I am sure you have already done this but I would call Michelle over at the Kane Center and see what she thinks... I know I am not much help... I had Medicare and Medicade so I didn't have to go through all this insurance stuff like most of you... It breaks my heart to see some of the struggles you all face... Hoping it is all OK! Jenn

Michelle is gone already for the day, so I am calling the insurance.  (on the phone now, on hold of course)   This lady is thinking that it's just a typo on their part.  Do you have any idea how upset I will be if this isn't right and it wasn't approved??  I will just cry!

Saying a quick prayer for you... Keep us posted! Jenn

Yeah, I think it is a typo. The person that did it was probably thinking of something else when it was done (unforgivable in my opinion they need to be just as exact as a bank). Ask the person that you get on the phone what the coding is and make sure that it is for RNY and not the band. Chris ps   they will sometimes just put down the bare minimum of days for the hospital stay. I have had that happen in the past for surgeries. BCBS will say that the routine and customary for such and such surgery is X amount of days but the doctor can counter and say the patient is going to stay X amount of more days.

Okay here's what happened.  She said that since there is no actual surgery date yet, they just put outpatient.  As soon as I get a date, I just call them and they change it to 3 days stay.  (and use the dates that I give them).

HUGE sigh of relief here!!  You are right though, they should put that somewhere.....well at least I know that my heart and lungs are good! lol

That sorta makes sense.  Chris

Hang in there honey.  It will be OK.  They always make typos.  Like you could have your insides re-arranged on an out-patient basis!!!!  GEE WHIZ! They paid for everything for my surgery except the anesthesia, get this........because they do not pay for anesthesia if it is administered by the same doctor doing the surgery!!!!! Obviously, I did not have my surgery done in a vet's office (no offense) and once the hospital's billing department showed them the error, they paid in full.  Funny thing was, that my co-worker had cancer surgery at the same hospital a couple of months before me and he had the same problem.

All is well.  Doncha just love insurance companies!!  they suck most of the time. 

When I worked for the ob/gyne we had a 24 yr old pt who was diagnosed with uterine cancer and needed a hysterectomy to save her life and her insurance gave me the run around (I did pre cert at the time) because she was 24 and didn't have any kids!!!  I said, "ummm she's not going to have kids anyway, if she doesn't have this done she will be DEAD!"   they pre certed it and paid in full.  I just shake my head

Call the Kane Center and talk to Michelle, Maggie, Bessie, Donna or Maria whoever it is that handled your paperwork and tell them what you received. They get and exact copy of the paperwork that you get. They can straighten it out. Christine