Help! Help! Surgery is Wednesday but I just got a call saying there was a mistake with...

  My Doctor's office has the ref# from when they spoke to BCBS. BCBS very clearly told my doctors office that I was covered 100% with no out of pocket pay since I met my deductible. As of this afternoon, BCBS admitted that "Courtney" was very wrong in what she told my doctor's office.  So to answer your question, no, I have nothing in writing. My doctor's office might have something, but I do have the ref# and them admitting their mistake. 

    I will ask but I have yet to find any record of an insurance company "fixing" a "mistake" like this online. I will still ask BCBS, the worst they can do is tell me no!  I think the worst part for me right now is that my surgery is a little more than 24 hours out if I were to have it. It is just mind blowing that I was so happy a few hours ago....and then BAM! 

This STINKS!  I am so sorry.  Maybe you could try a medical loan.  Here are some links:

Avant Credit Solutions

American Healthcare Lending​

​United Medical Credit​

Try posting this on your surgery type forum and we also have an insurance forum.  Here is the link:

Insurance, Cash Pay and Financing

One of our staff members has a lot of experience dealing with the insurance companies.  Her name is Sarah.  I will give her the link to this post and see if she has any suggestions.

Hang in there and again I am so sorry.

 Thank You! I may look into these credit options, if I can't get anywhere with this mess in the morning. Thank you so very much for taking the time to help me. I am very lucky to have such wonderful "forum friends" ! 

      I pray that I get better news in the morning.

Thank you again,

izzi

I'm so sorry to hear this they didn't say if you could do a payments for your portion?

Hi, Izzi!  I've not worked for BCBS but have worked for HPHC.  Just to make it clear for anyone else reading this, I am NOT speaking officially on behalf of HPHC, as I no longer work for them.  Having said that, I would recommend calling BCBS Member Services and ask to speak to the department that approval hospitalization/coverage decisions.  I would then explain your situation and the emails you have to back up what you are telling them.  Ask them to reverse their decision based on documentation you have.  In my experience, they will overturn in your favor.  If they do not do so then, I would inform them that you are going to contact the Massachusetts Dept. of Insurance (If you are in Massachusetts) or whatever state you live in Dept. of Insurance and explain your situation.  At least here in Massachusetts appealing to the Dept. of Insurance is the next step to the appeal process if your own insurance company does not approve what you are asking.  Of course, your insurance company will not inform you of that right.  Good Luck!

Thank You!

  I will try that right now!

How would appealing help? BCBS isn't denying her surgery. It is stating a rep gave incorrect information about costs. I don't think the insurance commissioner or anyone else can do much about that.

Hi, Izzi!  I've not worked for BCBS but have worked for HPHC.  Just to make it clear for anyone else reading this, I am NOT speaking officially on behalf of HPHC, as I no longer work for them.  Having said that, I would recommend calling BCBS Member Services and ask to speak to the department that approves hospitalization/coverage decisions.  I would then explain your situation and the emails you have to back up what you are telling them.  Ask them to reverse their decision based on the documentation you have.  In my experience, they will overturn in your favor.  If they do not do so then, I would inform them that you are going to contact the Massachusetts Dept. of Insurance (If you are in Massachusetts) or whatever state you live in Dept. of Insurance and explain your situation.  At least here in Massachusetts appealing to the Dept. of Insurance is the next step to the appeal process if your own insurance company does not approve what you are asking.  Of course, your insurance company will not inform you of that right.  Good Luck!

UPDATE: TUESDAY at 1pm

      My day started at 8am bright and early on the phone with my insurance co. and my Dr's office. Lots of tears, and about thirty phone calls have taken place. It was decided that I was indeed looking at about 10,000-15,000 dollars in bills from the hospital and $2,000.00 from my surgeon's office. I am faced with having to pay the $2,000.00 today before 3pm if I want to keep my surgery date. 

    Also, BCBS said that they were not responsible for anything even though they did give the wrong information to my Dr's office in July.....I cried.....I begged.....I cried more, but tried to hold it together. I asked to speak to the "BOSS" and she told me the same thing, so I cried and thanked them for their time. Their point was that they (BCBS) had given the correct information to my Dr's office in March so that cancelled out the "mistake" in July thus leaving me with the first 50% of the surgery cost. I even ever so nicely mentioned contacting the State Insurance Board/Com. Nothing helped!

     I then called my Dr's office again and begged for the ability to make payments. That was a no. I then spoke with the manager and begged, and cried and begged some more. I got a very polite no, and care credit numbers and that kind of thing while the manager then tried to get me to just reschedule. I explained that there would be no rescheduling. If we couldn't make it happen today, nothing was going to change next week. I then called care credit.

    I was approved for half of the amount I need. I cried, then pulled my self together and called my husband. While on the phone with him I was being called by a number I did not recognize. I didn't answer. I continued to talk to my husband and told myself that it just was not my time yet. I got off the phone with my husband and thought about stuffing my face with food to make me feel better but I stopped before ever taking a bite! I then went to my bedroom and had a real good cry. The kind I had been holding back all morning while on the phone.

   Then my phone rang. I was surprised to hear Lisa's voice. Lisa is the very nice woman who works at the hospital. She is the one who broke the bad news to me yesterday. I had already spoken to her this morning and told her I would call her when I was 100% sure what I was doing. I know they are chomping at the bit to fill my space at the hospital if I cancel.  I about started screaming! Lisa had called to say that the woman from BCBS had just called her since she could not reach me a few minutes ago. Apparently after speaking to me the BCBS woman started looking into my policy more. She had called to say that there was a chance that my surgery could be covered 100%!!!!! WHAT???? Apparently the wording in my policy was unclear and needed some investigating. HMMMM...okay, I will take it!

    One hour passes and BCBS calls me back and is still looking into the unclear wording of the policy.

 My phone rings again, an hour past the last phone call from BCBS.  The woman says, you got it! The surgery is covered 100%!!! I scream! I am in SHOCK! She says she will call the hospital and Dr's office and inform them.  I am still in shock! I don't know what happened and what changed and neither does anyone at the Dr's office. I am okay with that.  I will be having surgery in the morning, and BCBS is covering the surgery 100% and I pay nothing.

   The doctor's office said that they have everything documented and if there is a problem later on down the line after surgery they have their ducks in a row.  

  I am drained! I am so very happy right now! Thank you to everyone who prayed for me or sent kind words or advice. Thank you so very much! I am so lucky to have you all!

izzi

YAY!!! I am so happy for you that this has all worked out! I know how frustrating it is to look forward to surgery and not know if it was going to happen or not. We were missing a lab for me, and after 3 blood draws, and two weeks, we finally got it back at 3pm the day before surgery. I barely had time to wrap my head around surgery actually happening. Everything after that went very smoothly. Good luck tomorrow! Try to get some rest tonight and you will do great!