BCBS Federal

I am looking for advise. I have a surgery date of 01/28 (which I received 3wks.ago)and am on the 2wk. liquid diet.When the nurse called 2wks.ago to give me my pre-op date she said I was all set but my insurance required pre-determination.She said I don't need pre-approval but I do need pre-determination. They were requesting an approximate cost. So she sent it to them and last week the said they haven't made a decision yet. I talked to her today and they told her yesterday they didn't receive the paperwork she sent so she faxed it to them. Today she told them I was having the surgery on the 28th and we needed a decision.
They said they should have one in a couple of days. My nurse said she is going to call again on Thursday and let me know. Pre-determination,pre-approval it seems like the same thing to me.They're going to pay/they're not going to pay why the distinction? Anyway I can't afford this and can't go thru with it without knowing. The nurse says she thinks everything is fine they're just being a pain. Has anyone had BCBS Federal in NH and had them cover the surgery. Sorry this is so long, I don't post much because it takes me forever to type.
Thanks,
Leona

Hello Leona,     I do not have BCBS Federal - sorry.  And others here are more experienced since I am pre-pre-op.  But I do believe that the bariatric program will not allow this to go further until they have the approval secured.  And that approval goes to you as the insured so you ought to have paperwork in hand with that commitment in writing.    If need be, can't your surgery date be pushed back a week or so?  Not that I don't appreciate the inconvenience that would cause, I sure do.  I do wish you the best of luck and let us know how things work out.  Treading

 

Thanks for your reply, and your right about thinking they wont go any farther until they have approval,but apparently they will. I was told they wouldnt give you a surgery date until checking with insurance.Thats why they have you wait a week after seeing the surgeon to call and give you the date. Oh well, the good news is, I got the call today and I'm all set.The insurance has already sent the "pre-determination" letter. yaaay!
Thanks again,
Leona