I appealed my denial and WON now insurance WONT PAY!!
My sleeve was denied by BCBS of CA. I then decided to pay for the sleeve out of pocket. In the meantime I appealed my insurance denial. I had the surgery and a few weeks later got a letter saying my appeal was granted. I told my doctor's office and they billed the insurance company who denied the claim b/c I had the surgery at a place other than a center for medical excellence so my insurance will not reimburse for the sleeve.
Has anyone experienced this? Is there anything I can do? It would be really really nice not to have to finish making allllll those payments to care credit.
Any advice?
Has anyone experienced this? Is there anything I can do? It would be really really nice not to have to finish making allllll those payments to care credit.
Any advice?
HI,
I hate to say it but if your benefits state that its only covered at a Center of Medical Excellence then they are not going to pay . You can always appeal the denial on the actual claim but there is no promise it will do any good. I work for BCBS of NC and we require that it be done at a Center of Distinction also. But as the policy holder you do have the right to appeal almost anything. I would contact your Customer Service department and ask them to walk you through what options you have. Some policies do have certain conditions and stuff that there is no hope for if it is denied, so be sure and explain the whole situation and see what advice they can offer.
hope this helps!!
I hate to say it but if your benefits state that its only covered at a Center of Medical Excellence then they are not going to pay . You can always appeal the denial on the actual claim but there is no promise it will do any good. I work for BCBS of NC and we require that it be done at a Center of Distinction also. But as the policy holder you do have the right to appeal almost anything. I would contact your Customer Service department and ask them to walk you through what options you have. Some policies do have certain conditions and stuff that there is no hope for if it is denied, so be sure and explain the whole situation and see what advice they can offer.
hope this helps!!