Question:
Have this insurance issue ever happen to any of you

I was just told today that bcbs refused to authorized my ecg the deemed it not medically necessary. How can they pay for surgery but not the pre test to make sure everthing is ok. I'm schedule for the other preop tests Nov 5 and afraid to go now. What if I go for the testing and get a bill saying bcbs want pay. I have called around to get answers but nothing as of yet. Any advice?    — shae7755 (posted on October 28, 2003)

October 28, 2003
Hi Shun, Bet you have BC/BS for federal employees. They stink! I have them also and they are just giving me the runaround about approval for the panniculectomy I need. I was denied 2 yrs ago by them when I had staple line disruption which needed fixed. They said that was not a medical necessity too. Bah humbug on them! I luckily had AETNA which covered both surgeries. BC/BS Fed is beginning to really be horrible about everything we need. Well, BC/BS had better watch out because open season is coming up and I, along with a lot of others, are changing insurances! They cannot continue to take our money and then not cover anything. I am sure this billion $$$$ company will not miss my contribution but if they keep on messing everybody over we should all quit them! If I were you I would go ahead and have the preop tests, they cannot deny these because the preop testing is NOT an exclusion in my policy. They are just trying to discourage you. Go for it anyway and if you end up having to pay for the tests you can make payments to the hospital if they truly deny it. My problem is they won't give me a straight answer......nothing on paper.....just verbal denial. I will fight them to the end of all my ropes and if they continue to do me this way, I will have to switch to another carrier, but I will try, try, try to get approved. Never give up!
   — Mylou52

October 28, 2003
I have BC/BS FED and they have paid every single pre-op bill that has been submitted for me. I was told by BC that, in the case of gastric bypass, they usually deny the claims at first and then after the actual surgery is approved and paid they resubmit the original bills and they are paid retroactively, because until the surgery is actually NEEDED, the tests are NOT medically necessary. Maybe they will pay your pre-testing then. Why don't you ask them if that is the case with your policy? ALL BC/BS POLICIES ARE DIFFERENT!!!!!!!!!!
   — CAMFR

October 28, 2003
You know the sad part about all of this I can't have surgery without that test being done and bcbs knows this. So why not approve the surgery when they can stop you from getting the test they know people don't have money to pay for this and that well at least I don't.
   — shae7755

October 28, 2003
Sorry I meant egd the most important test for surgery and I can't get approved but I'm approved for surgery How funny
   — shae7755

October 29, 2003
Every single insurance company has an appeal process. Don't worry about the non-coverage of the EKG just yet. Wait uhtil after you have surgery, then submit anything they should have paid with an appeal letter. Be sure to send copies (not the originals) with the letter.
   — koogy