insurance

i have bcbs health options. My dr. said that one of thier patients also had this ins co. The person had approval, went through with the surgery and then bcbs said they wouldn't pay because it wasn't medically necessary. Even though the person had pre approval. They said that just because there was authorization it doesn't guarantee payment. Why bother getting preapproved? has anyone ran into this problem.

Unfortunately, I have heard of this once before. A friend from work had the same thing happen with Aetna and she is still battling with them, her surgery was in October 2003. Her parents came through and paid the surgeon to keep him from denying her the follow-up care after surgery, but they continue to fight with the insurance company to get that money back. Her BMI was over 50 and she had diabetes, sleep apnea, depression and lots of pain (all are gone now and she is 130 lbs lighter). Just doesnt make a lot of sense the insurance company didn't feel surgery was necessary. I hope this doesn't happen often. Amy

Once they approved they have to pay. If she has a copy of this in writting I would write the Insurance Commissioners office and the Lt. Governor's Office. Send copies of everything. If she does this then they will or should honor their agreement prior to surgery.