Question:
I was approved by BCBSMD and now.......................

I receive a statement from them from the Hosp billing stating they are not covering a weight loss procedure, and this bill alone is $8000.00 what can I do?....has anyone else ran into this and what did you do? I dont even have $80.00 at this point.    — Schatzie1 (posted on October 18, 2002)

October 17, 2002
call your insurance company, the custumer service line. BCBS has been known to do this before. I think it is criminal, but they can do it. You will have to appeal and you will have to fight them
   — Vicki L.

October 17, 2002
That happened to me after I was approved and had surgery. I began getting statements from them saying that this was not a covered benefit. I called my bc/bs customer service. The first person I talked to said that I had never been approved even though I got a letter stating that I was approved. I called back and spoke to someone else after finding my approval letter. She was very helpful, was able to find my authorization, and sent my bill back through to be paid, I took her name and was told that I could ask for her if this continued to happen, which it did several more times as the bills started arriving. Each time I got a letter stating something wasnt covered, I called and they fixed it. It is a pain! Good luck!
   — maryburton

October 18, 2002
I just had this same problem today. Although it was just a pathology bill for $210, compared to your $8,000, I feel lucky. I spoke to customer service at BCBS (1-800-258-8000)they said that things were being denied because we didn't send back their form asking if we had other insurances. Well, we did send back the form, but they didn't receive it. So, for every bill for my surgery now, I'm going to have to call and get it fixed. YUCK! I certainly hope that this all works through! I'm not liking BCBS very much right now!
   — cklaver

October 18, 2002
Try not to panic ... sometimes the people processing the bills aren't so swift ... they miss preapprovals already in the system. Personally, I don't think the hospital would have ever admitted you, nor would the surgeon have operated on you, if they didn't think they were going to get paid. If you don't get anywhere with customer service at BCBS, call the hospital & see what they say ... chances are they have already contacted BCBS. They want their money! I had a similar problem with BCBS Care First. They paid my hospital bill & then denied surgeon's bill. I called them & the woman said that someone made a mistake. They reprocessed the bill & it has now been paid. Don't let thrse problems get in the way of you being successful with this surgery. Take care of yourself & good luck.
   — Valerie B.

October 18, 2002
BCBS and many other insurance companies routinely deny charges sent with a morbid obesity diagnosis (278.01). Since I was approved by their HMO component, I not only had my pre-op testing charges denied at first (at an authorized hospital facility for a pre-authorized surgery no less) but I had to call back a few times to make sure they followed up on my initial calls. The point is that they will *USUALLY* deny routine bills associated with that code unless they were SPECIFICALLY pre-approved. My advice is to be persistent, file all your pre-authorization papers for reference later, and follow up consistently. Log all conversations and start listening for the names of the representatives when you first hear them. Except for one bill that was technically out of network (surgeon assistant), my total surgery costs were $15 after I kept after them. If your insurance is covered.. most other items are too. They just hope you will not keep after them even though you are entitled to those benefits. Good luck.
   — Gina G.