Question:
Has anyone been approved for surgery, but not have Dr. office visits covered?

I have Independence Blue Cross Blue Shield, and was approved for surgery very quickly (after 1 day), however I received a letter today from them stating that my office visits are not covered. They stated that they cover surgery for morbid obesity, just not the Dr. visits. Has anyone run into this? If so, did you have any recourse? This is one of the most obsurd things I've heard so far!    — Johannah D. (posted on June 7, 2002)

June 7, 2002
You need to file a written letter of appeal. Most times the office visits prior to surgery or authorization are not covered but once you get the surgery approved you just need to write a letter of appeal referencing the auth # and you should be ok.
   — Heather ..

June 7, 2002
I HAD TO HAVE THE DR. OFFICE RESUBMIT THE BILLS FOR MY CONSULT, BLOOD WORK,AND ANY OTHER TESTING THAT I HAD PRIOR TO BEING APPROVED. I WAS GIVEN A REFERENCE # BY THE INSURANCE CO. AND TOLD THAT THE DR. OFFICE HAD TO USE THAT WHEN RESUBMITTING THOSE CHARGES. I HAVE NOW STARTED TO RECEIVE STATEMENTS FROM THE INS CO AND THEY HAVE BEEN COVERED! YOU REALLY NEED TO KEEP AFTER YOUR INS CO. THEY CAN BE REAL A**HOLES AND IF THEY THINK THAT YOU WILL JUST GIVE UP THEN THEY WILL GIVE YOU A HARD TIME. DON'T GIVE UP!!! GOOD LUCK TO YOU!!!!!
   — nikki R.

June 7, 2002
I work for Independence Blue Cross/PA. It is true that the office visits are not covered. It depends how the provider bills the insurance company. If they use morbid obesity as a diagnosis, it will not be covered. You can try the appeal, I'm just not sure how often they overturn their decisions on issues like this. But it is definitely worth a try. Best of luck!!!!
   — amd0721

June 7, 2002
O jave BC/BS of NOrth Dakota, and they pulled the same thing. They billed me for my surgeon's office visit. I called them and brought it to their attendion and they reveresed the charge. I'd call the office again because I don't see how they can charge you to see the surgeon when you have been approved for the surgery!
   — blank first name B.

June 7, 2002
The insurance company is probably not covering the office visits because of the diagnosis code your doctor's office is using. There probably using the diagnosis code for obesity or morbid obesity (278 or 278.1). They should use another diagnosis code. My doctor uses the diagnosis code for malnourishment (I know, I'm the biggest malnourished person I know!!) but the insurance company pays for my office visits every time.
   — Patty H.