Question:
I was wondering if there is anything I can do?

I have BC/BS through my work and when I called them today because they denied a claim they said it was because I am only allowed one pre op and one post op visit and that is all that is covered. Well they covered my one week and my one month but now they said they will not cover anymore. Now I have a second insurance through my parents BC/BS federal. Well my mom had surgery to come to be told that even though she had pre certification it would probably not be covered and now we haven't heard anything from the hospital or the insurance company on whether it was covered. So if they do choose not to cover the surgery then they will most likely not cover my follow up visits either. I do not know what to do! If they don't cover it I cannot afford to go and see him either. What do I do? I tried to call the surgeons office but I was on hold for twenty minutes and then hung up. I will try and call again. 6/27/03 292/228 Can I ask them to code it differently since alot of my blood counts are low? I am just at a lose. Thanks in advance    — horserider0146 (posted on September 24, 2003)

September 25, 2003
My surgeon's fee covered all post op visits for a year. (which is today!) Check with your sugeon to see what they say.
   — April A.

September 25, 2003
My insurance only covered visits to the surgeon for 90 days after the procedure, but I only pay my co-pay for any visits after that. In the mean time, I followed up with my PCP, who checked my labs at my usual visits with him. You don't necessarily need to see the surgeon (or your PCP) to have labs done. Perhaps you can explain the situation to your PCP, have him order labs, and have the lab results faxed to your PCP and/or surgeon for review. If you need to add something (potassium, iron, etc.) it can be prescribed without you having to see a doctor. If you or your mom had authorization for the surgery, do you have any proof, like a letter or authorization number? If you do, and they are now saying they won't pay, you can always appeal the denial of payment.You have to do the leg work here - don't expect the hospital or surgeon to do this. They just don't have the time or staff. Find out from your insurance comapany what they paid the hospital, surgeon, and anesthesiologist. Good luck!
   — koogy