*** I new better *** INSURANCE ?? **

I'm so confused.

I wanted to find out what approximately my outlay of money was going to be for my surgery.  So I called the BC/BS number.  The first person said I need the medical code for the procedure.  Okeedokee...called JH and get it.  I call back to BC/BS and a different person gave me a long drawn out explanation when I told her I had the code.   

She told me that I'm not "approved".  Even though Dr. Steele's office congratulated me and said "you are approved".  Do I understand correctly, that the insurance company has already reviewed the medical notes from my doctors and agreed that I have a medical necessity and has approved my surgery?  This insurance person told me all I have is permission to be admitted to the hospital.  And that it is still subject to medical review.  AND that they NEVER pre approve surgeries.  Did I get a bum insurance contact or is this really true?  And do I have anything to be concerned about.  When I called BC/BS the other day, the woman used the words approved when she spoke to me and that's how I knew to call Dr. Steele's office and again I was told you are "approved".  So  me thinkest I should have left well enough alone.

Hiya Mari!

It sounds to me like you really did get a bum service rep from BCBS........The surgeon's office wouldn't say that you were approved unless they heard it directly from the horse's mouth.  I wouldn't worry about it though.  As for the outlay of cash by you, I would probably hash out the numbers with your HR rep or talk to someone higher up at BCBS.

Hi Aaron!

You know...thinking back, after I gave the woman the medical code for the surgery I realize she was reading to me, and when she got to "you must have a BMone of 40 or a BMone of 35 with corn-moan-o-dites"  I realized I wasn't talking to the most experienced rep.    I think I'm going to leave well enough alone.  The only reason I was inquiring was I have a Flexcare account with money that I need to use by 12/08 so I was curious if I had enough.  I think I do...but the next problem is I don't think my surgery date will be in '08.  I'm pretty sure I'll be into 01/09 already. 



 

oh that happened to me.  I had over 700 dollars in my flex plan to cover any out of pocket expense last year becuase I thought my surgery was going to be by September of last year but things happened with my dieticianand I got pushed to May of this year.  I lost all that money.  I was so upset.

A BMone?????    OMG!!!!

I HATE BC/BS with a PASSION!!  They laid my Mom off after 15 years.  GRRRRRRRRR!!!

I wonder if the insurance coordinator at Dr. Steele's office would call them for you?  I'm sure they know all the lingo.  Maybe that would help?

Good luck and hang in there!!  It CAN be really frustrating, but just look at every bump in the road as a means to the end!!

Tia

 Tia...Yes!!  BM-one  and could barely pronounce co-morbidities.  At that point I just said thank you and hung up.  This is not the first time I've gotten conflicting information from them. 

Tia, that's awful about your mom....15 years is a long time to devote to a company and then get let go....very very wrong!!  I can understand why you'd have a very personal dislike for them...

I'm going to let it go.  I know I'm approved, just waiting for my date which should come early next week and you're right, I'm keeping my eye on the prize. 

i had that problem a few years back did all the **** and then insurance said i had coverage but when doc went for it NOOOOOOOOOOOOOOOOOOOOOOO  so all over again this year with new insurance

Hi,

You mean they told your doctor you were approved and then changed their minds?  Can they do that?

 

NO  i mean the person whom answered the phone with the insurance company gave me the wrong information , they dont have the most reliable people answering the phones so if your docs insurance rep in the office called and got approval i would not worry about it that means you are covered. I even had the reps name and all and they still argued with me saying they are not allowed to give that information to us , like i lied or something dont need to tell ya how peeeed off i was lol , but as i said the docs office will make sure your covered before they do anything. They know all the loop holes and all so again if he said yes your covered then most likely you are on your way to the loosers bench

ah...ohkay.  So does your insurance cover it now? 

I agree with you I think I'm okay.  The docs office submitted the letter of necessity and my paper work and they told me then that I was approved.  I don't know why this insur rep didn't know about bariatric surgery, I think its handled a little bit different than other surgeries. 

I hope you get squared away soon.