Help insurance problem!

HI Everyone, I have a big problem with BCBS , I talked to someone yesterday about the status of my approval. Im not sure what to believe but so far I heard she is wrong by some people but she told me that they dont approve you till AFTER THE SURGERY!! I was shocked because like I told her I never heard of such a thing. My husband told me I should of asked her to speak with their supervisor but I was so upset I couldnt even think straight. She started telling me that they do the same with breast reduction, why she told me that I have no idea. Has anyone ever heard of this? She said it has something to do with the surgeon and if its medically necessary. I was like OF COURSE ITS medically necessary or I wouldnt be having it done. It was so frustrating because I can never get a straight answer from anyone at BCBS when I call. They keep telling me to call pre certification for answers but when I call them they tell me the same thing. Im at loss for what to do now, since no one seems to be abel to help me. Im still waiting on approval from them which I know is the hardest part, but after talking to that person I dont know what to think. If anyone has ever heard of this please let me know what I need to do. Thank you any help. Denise

I have MUSC option insurance which is managed by BCBS. They definately have to approve mine first. I doubt if your surgeon would do it without the preapproval. I called them 4 times yesterday, and got a different answer each time. Trying siccing your insurance company on them. The way that I believe that it works is they ask the surgeon for the documents to prove that it is medically necessary, then make a decision. Good Luck Mary

When in doubt call your surgeon's ofc and let their insurance person call them to clarify. Believe me they can get answers because they want to be paid. Joan M

HI Joan, Thanks, I did call my surgeons office and was told that she was wrong in telling me I had to have surgery first before being approved. Sometimes I dont know who or what to believe anymore because I get so many different answers from the insurance co. Seems like when ever I call, there doesnt seem to be anyone who can answer my questions right. Im still waiting on approval but when ever I call they tell me they cant tell me anything. Oh well I guess I just have to keep calling my surgeons office and hopfully they can give me the answers. Thanks again Joan Denise

Try to get some help from your Gastric Bypass Surgeon's financial office ... They should be the ones filing your request & medical information so BCBS would have all the information to veryify medical necessity. Also, any surgical practice worth it's salt would already know what BCBS requires for you to get approved. You normally cannot get approved without going through your Gastic Bypass Surgeon's office & they are the ones who should be walking you & your paperwork through the insurance maze. No, I've never heard of an insurance company refusing to authorize any procedure until after it is done ... That doesn't make sense because if they don't authorize then you are financially responsible ... Who could come up with $30,000.00 or more at the drop of a hat? Also, medical necessity is verified from your past medical conditions & current medical status ... You need help from your surgeon's office who would get your medical background from your other doctors. The way it is usually done is that your Primary Physician would refer you to a Gastric Bypass Surgeon ... then you'd follow their procedures to file your medical records & supporting documents. Sometimes you need to get a Letter of Medical Necessity from your Primary Physician &/or from specialty doctors such as those handling your co-morbs. But, in most/all cases, your Surgeon's financial office would know in advance what records & supporting documents & Letters are needed & an entire packet would be filed from their office to BCBS or whatever insurance company. Sometimes you get your surgery date set up before your approval arrives but as far as I've always heard, the approval always arrives before surgery is done. Hope this helps ... God bless you ... Dawn & Nick

Hi Lady D Thanks so much for all the info. You have been a great help to me and I sure appriciate everything you do for people like me who need to be educated on this process we have to go through for this surgery. It sure is tough sometimes but Im sure will be well worth it in the long run. I sent my letter from my PCP to my surgeons office on Monday and I just got off the phone with them to see if they sent it yet and of course she puts me on hold and then comes back to tell me she is just sending it NOW! What a dissappointment, she is the person in charge of all insurance documents but to me she is very incompetent. Well Im at work so I better get back. thanks again Lady D Denise