Is this an approval letter???? HELP!!!

shell0995
on 6/12/06 7:44 am - Farwell, MI
In the mail today came a letter from BCBS of Texas. It says: Patient Name: Michelle W. Dear Provider, Thank you for your recent inquiry regarding determination of benefits for the member named above. We appreciate the opportunity to serve you. We have determined that 43644, as outpatient done by a medical doctor is eligible for benefits under the member's health care plan. According to the benefits and provisions of the health care plan, 43644, as outpatient done by a medical doctor is covered as follows: THIS IS WHERE IT LISTS IN NETWORK AND OUT OF NETWORK AMOUNTS. Please be aware that this is not a guarantee of payment. We will complete final determination of eligibility, allowances and disposition after we receive the claim and any supporting medical documentation, such as an operative report or physician's notes. DOES THIS MEAN I AM APPROVED???? It's too late to call the office and find out what this means! HELP!!!! Michelle
Linda Ton
on 6/12/06 7:58 am - Pontiac, MI
Michelle this is very confusing. It sounds like you don't need pre approval and they will pay as long as it's in network....but don't count on that as approval. Have you tried calling and asking? Since when is wls outpatient? I hope you get your answers. Hugs Linda
Sugar Free Lauri B
on 6/12/06 12:38 pm - clinton township, MI
Sounds to me like it is saying your Ins Co covers it, BUT you need to meet whatever there requirments are. Just my opinion on it though. -Lauri B
shell0995
on 6/12/06 12:48 pm - Farwell, MI
I posted on the Texas board also since my BCBS is from Texas. Another person had their BCBS approval letter read the same and they had their surgery. She said it's a general 'statement' most of the insurance companies in Texas put on their letters. My surgeon's office sent in all my paperwork about four weeks ago. They said it would take about 3 weeks (give or take with snailmail). So that is why I am confused. I just wish the surgeon's office would have been opened when I opened that darned letter! I will just have to wait until tomorrow.
Most Active
Recent Topics
×