Question:
Having a problem with BC/BS of Mich not covering preop testing

Iam going through BTC in Ypsilanti Mich and have already been approved for surgery. I thought all of my testing would be covered no problem. Well, yesterday I received something in the mail from Blue Cross. It was an explanation of benefits form regarding the pulmonary function test I had on Oct 9th. It said that my pulmonary function test was not a covered benefit. I called Blue Cross to find out why and they tried to give me some song and dance about nothing related to weight loss being covered. When I mentioned to them that my WLS was approved they said something about getting an authorization number that BTC would have gotten from Blue Cross. Well, called BTC and everyone that I talked to pretty much said they didnt understand why I was having such a problem and that their Blue Cross patients have never had a problem with this before. Oh, by the way when I mentioned getting a authorization number they said they dont have authorization numbers on their forms, Its just some kind of form that they use for their Blue Cross patients and it just mentions that Ive been approved (no authorization number). If I dont get some kind of number Im looking at a $724 bill just for the pulmonary function test. I can only imagine what the bills are going to be for the stress test, echo, and sleep study. Has anyone with Blue Cross and has gone through BTC gone through this problem? If so what do you suggest I do? I'm getting extremely frustrated! Thanks!    — Kris T. (posted on October 24, 2002)

October 24, 2002
I would double check with BTC on the cost. I have traditional BCBS of Michigan through Ford Motor Co. and had my surgery at BTC in Ypsilanti. 2 years ago my BCBS paid for everything except the initial $85 consult fee and the fee for the pre-admission testing (which included the pulmonary function testing, EKG, labs, urine, assessment, etc)...which was $175.
   — Lynette B.

October 24, 2002
Hi Kris. Did you get an auth letter from BC/BS? It will have your auth/ref number on it. I had the same problem with BC/BS and after calling them back with my auth number they fixed the problem. They automaticaly deny charges that have a diagnostic code of obesity on them. I have had to call them over several charges and so far they have paid them once they were shown that I was approved for the surgery. Good Luck!
   — maryburton

October 24, 2002
I was initially denied for my pre-tests Anthem BC/BS needed a note from my doctor saying they were necessary for the WLS then they paid.
   — Candace F.

October 24, 2002
I have the same problem with them deniying the one part of the function test which is where the Dr reads and interprets the results of the meter thing. They are charging $40 just for this which the say is not a benefit. I havn't tried to fight it yet but everyones policies are set up different all my pre admission testing came up to $170.00, my 10% copay. Can't hurt to keep pressing the issue with them.
   — Rebecca B.