Federal BCBS Insurance Journey - VSG
Hi Everyone,
Fed BCBS - Denied VSG at precertification on May 07, 09, due to being investigational.
First Claim turned in and then returned due to no medical records being submitted.
Claim was denied because I did not met the medical criteria, the claim was submitted with CPT code of 43659 which was the wrong CPT code.
Corrected claim was resubmitted with the corrected CPT, 43843. Claim was paid in the amount of $2221.33 for the hospital stay. $981.71 for removal of band and VSG.
I submitted an appeal, because of the did not met the medical criteria denial with a letter of medical necessity from my doctor. The outcome was an adjustment with an additional $1288.65. At least I got something, I'm very grateful!!! My doctor was an out of network provider. It's funny that I feel as though I had gone to Mexico to get the surgery done, without really going to Mexico because of the cost of the VSG was $12,500.00 and I received reimbursement of $4,491.69. That is a big time blessing!!!
I do not regret going with Dr. Broussard, even though I had to pay $8000.00 it did not matter to me. He is excellent in my book. I'm getting rid of this extra weight and feel like I have a new lease on life.......
Blessings to you and your family
babygirlinokc
Fed BCBS - Denied VSG at precertification on May 07, 09, due to being investigational.
First Claim turned in and then returned due to no medical records being submitted.
Claim was denied because I did not met the medical criteria, the claim was submitted with CPT code of 43659 which was the wrong CPT code.
Corrected claim was resubmitted with the corrected CPT, 43843. Claim was paid in the amount of $2221.33 for the hospital stay. $981.71 for removal of band and VSG.
I submitted an appeal, because of the did not met the medical criteria denial with a letter of medical necessity from my doctor. The outcome was an adjustment with an additional $1288.65. At least I got something, I'm very grateful!!! My doctor was an out of network provider. It's funny that I feel as though I had gone to Mexico to get the surgery done, without really going to Mexico because of the cost of the VSG was $12,500.00 and I received reimbursement of $4,491.69. That is a big time blessing!!!
I do not regret going with Dr. Broussard, even though I had to pay $8000.00 it did not matter to me. He is excellent in my book. I'm getting rid of this extra weight and feel like I have a new lease on life.......
Blessings to you and your family
babygirlinokc
Virgie Tschirhart
Lap Band - 2008, Sleeve - 2009, RYN - 2017
Started Program Weight July 13, 2017 - 194.2
Before Surgery Weight December 27, 2017 - 185.0
Current Weight - February 2018 - 161.0
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