Question:
My insurance tells my surgeons office one thing and me another.

I have been calling my surgeons office and BCBS of NC for at least a month now trying to get a concrete approval and I am so frustrated. When I call BCBS they advise me that they have talked to my surgeon and there is no pre-apporval needed because the code that the surgeon will be using when filing the claim is for medical necessity. Now my surgeon has taken photos twice and sent them to BCBS to get approval. I have a huge hernia and a hanging "apron" that does cover the pubic area. Now when I talk to an administrator of the hospital where I will have surgery, they tell me that I may be held responsible for the tummy tuck portion of the proceedure as they (the surgeons office) have been advised that the tummy tuck is considered cosmetic and they do not pay for cosmetic proceedures. So my question is: Why did we take photos not once but twice and should I proceed with the surgery and just wait to see if they deny part of the expenses for the tummy tuck portion of the surgery? I just want to hurry and have the hernia repaired, it's getting bigger and I feel sick to my stomach a lot. Which I beleive is because of ther hernia. But I do not want to have the hernia repaired and then have to be put under anesthesia again for the tummy tuck when I can take care of both at the same time? So what do all of you post-op plastic surgery members think, go ahead and have the surgery, possibly duke it out later with BCBS or try to get the definite preauthorization from BCBS that I have been told so many times I don't need? By the way it really pisses me off that I'm doing alot of the leg work that I feel the surgeons office should be doing. Am I justified in feeling this way? Any advice would be greatly appreciated.    — Terri N. (posted on September 24, 2002)

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