Champva Coverage/Denial(long post)

I had Roux en Y Gastric Bypass done the middle of November.  Prior to the surgery, I called my insurer, Champva, and was told that the bariatric center was also calling to verify coverage eligibility.When I called,  I was told that the surgery was a covered benefit if deemed medically necessary and that there were no comorbidities needed if the BMI was over 40 (mine was). The insurance verifier at the bariatric center then called and told me that the surgery was a covered benefit and I appeared to meet all the critera so I could move forward in the process. After I completed all my nut visits and saw the surgeon, the paperwork was to be submitted to the insurance company. My doctor's office called a week later and told me that Champva does not give pre-authorization and as such I would need to sign a paper saying that if they did not cover the procedure, I would be responsible.  They also told me that it was a formality and they saw no reason why it wouldn't be covered as I met all the necessary critera.  About a month ago I recieved a letter  from Champva to the hospital and myself, saying they had denied the hospital bill and asked that it be resubmitted with the history & physical and operating reports.  I haven't heard anything further, have never heard anything from the hosptial at all.  Then last week I got an EOB saying that the doctor's charges were denied as not a covered benefit.  I called Champva and after 30 minutes of them trying to figure out why it was denied when they thought it should be covered, they finally came back and said that it was denied because it was billed as code number 43645 and that is not a covered service, but I should check and see if perhaps it was a typo because 43644 is a covered benefit. I called the Dr.s office and they said, no it was not a mistake, it was billed as such because I have a limb greater than 150, making it a different procedure code.  They also kept saying that they didn't understand why the were saying it wasn't covered because Medicare pays for both and Champva normally pays whatever Medicare pays. I was never informed that the coverage was limited to a distal procedure and the doctor's office doesn't understand why they won't pay.  Now I am stuck with a $20,000 doctor bill and if they will not pay for that, then they will most likely not pay the hospital portion either, which is an additional $36,000!  Is there anything I should know that could help me? Is there anything I can do?  Appeal?  I am overwhelmed by this and I feel that somehow someone dropped the ball.  I don't understand if there were limitations, why neither the bariatric center or myself were informed of them.  Can anyone give me some advice on what to do next?

Hello there,I'm sorry your going through this. If you dont have a copy already,get a copy of your coverage that specifies whether or not you have covered.If you have documented who told you it was a covered benefit and get copies of whatever code was given would be helpful too. I'm really not familar with the plan that you have,but I would definitely appeal,but I worry that if you have signed a document stating you'll pay for services if not covered you may still be responsible. It just doesnt make sense if it was a covered benefit why they would have you sign something like that? You may have to back track and request aperwork that states what they have done to make sure they did document everything correctly.Thats the only way to find out what they have done before you appeal. I hope that helps.I wish you the best.