LONG-VENT Insurance will not pay for my surgury!!

So..I had my band 6/26/08. I get a letter from Dr. Roye's office stating the Blue Cross is not paying for my surgery and if I can't get it resolved I am responsible for it!!! What the @#%&!!! I was aware there was a problem but was told it would be worked out. So I call the billing lady and leave a message that I need all the paperwork that was submitted so I can file a grievance with Blue Cross.  That was Thursday..NO call yesterday but I did get a detailed bill from the JERK!!!! I am so pissed off right now!!! I knew that there was a rider on my policy that special approval had to be granted but was told by the DR office it was all set! I knew I should have followed up but it's been 6 months!! And the 1st of the year the plan now allows all barbaric surgeries so I would have waited!!!  I am so tempted to call DR ROYE directly but I want  to try to submit the appeal 1st and see what that brings. If the billing lady will get me the copy of the approval I will have a better leg to stand on with Blue Cross and HR at my husbands work if needed. I am in for a long fight!! $3900 to Dr Roye and $20,000 to the hospital....UUURRGGGG
MERRY CHRISTMAS TO ME!!!!!!!!!!
Thanks for listening!!!!!
Jaime
OH and by the way I keep filling my face to drown the pain!!!! Old habits don't ever go ahead!!!

Oh Jaime ,
  That suck big time I am so sorry to hear what you are going though.  I hope they can fix this for you.  I will say a pray for  you .

Lisa

Jaime,

That truly sucks!!! I feel your pain! My insurance is giving me the run-around right now. They only paid partial. What's that all about? Now I'm getting bills from the hospital for over $9,000! The doc is paid but WTF?

I think you're doing the right thing. Appeal the heck out of it! That's the way I'm working it here.

Meanwhile, try to focus on this week before Christmas to do your holiday schtuff then put your full efforts in AFTER Christmas.

Enjoy the season! We'll have a White Christmas this year! That's so cool!

Jules

Thanks!! They paid $3000- to the hospital. I owe them another $ 18,000- (ha ha I will bend over and pull it out!!)  They paid nothing to the Dr...kicker is the bill from the doc has the 1st appt. 2/13/08 as un-paid???? They never mentioned this before????? OMG I passed up on a fill last appt. Now I'm afraid if I need one they will not see me until they are paid!!!  Geez it is so hard to take it step by step when they keep crashing in around me!! I will prevail.....All my stress eating has helped me drop 2 more pounds...GO FIGURE...
Thanks again
Jaime

Jaime, 
Put on those boxing gloves and give Blue cross a call.  I don't believe the surgery would have even taken place if there wasn't some kind of approval.  His office doesn't seem to take that kind of stuff lightly.

Good Luck
Nancy

I was told today by the Blue chip lady at University Surguical that the approval was verbal. She was going to talk to Anette and Dr Roye today and see what king of proof we can drum up for the appeal. It's going to be fun. If need be I will get a lawyer. I told the lady @ dr roye's office..What going to happen..Ya going to take my band back?? LOL She didn't laugh though..but I was happy she was getting Dr Roye involved.
Thanks

I have kept all my EOB (Explanation of Benefits) from BCBS, they all state what they paid to the hospital/Dr/Anthesiologist, and what I owe...I am hoping that this is it! Try to see if you got any of those EOB's maybe that will help.

Good Luck