Question:
has anyone heard of there insurance denying the surgery but covering the hospital nd

   — tim B. (posted on July 17, 2003)

July 17, 2003
Tim - I work for a doctors office that does the procedure. I work in the insurance department. We have this problem most of the time after the fact. Insurance companies, BCBS for example, will pay everyone else except for the surgeon. Then we have to file an appeal. Also for Medicare they pay seperately for hospitals and doctors. If I can help any further let me know. Hope this helps!
   — Ashley S.

July 17, 2003
Sounds like my tale of woe w/CIGNA who had pre-approved me then demanded lots of additional information after I had had the surgery. Ultimately, they authorized the "hospitalization" but then refused to pay the surgeon asserting that the "operation" had not been approved. They have since declared that they need additional information from the surgeon before they can pay him. Hmm. . . sounds a tad suspicious.
   — SteveColarossi

July 17, 2003
I'm going through the same thing now. I have asked for a reveiw by my insurance company and today was turned down. I have no recourse but to ask the doctor to take a lessor pay and make payment arrangements . The insurance paid the hospital and the doctor who puts you to sleep but did not pay the surgon or the asst. surgon.Most Doctors will take a lessor pay rather than get nothing.
   — myra J.

July 17, 2003
I had the opposite problem. I have GHI/Empire BC BS and I was denied in May. GHI said they would pay surgeon but Empire BC BS said they would not pay for the hospital stay. They wanted me to diet for 6 months. I used Walter and Kelley Lindstrom to handle my appeal and they helped me win my case.
   — Lisa N.