Heath Insurance Denied

I got the letter just now, very frustrated.

My BCBS of Il denied me because my hospital is not a BDC. Does any one know what that is?

Im heartbroken. I thought I did everything right, my hospital said that they took BCBS. I even called my insurance 6 months ago, they said everything looked good. I got all my approvals (social worker, dietician, surgeon). I've followed my 6 month diet (lost 20lbs). I've done so so much research. Las semester I travelled between Ohio(college) and Illinois(home) to make to my appointments. I even took this semester off of school to get my surgery. My surgeon and the other hospital staff told me that there should be no reason I wouldn't be  approved, that I was a basically a go.

Im totally in shock. I don't know how I missed this. So bummed. Is there even a point to appealing it if I got denied for the hospital not being a BDC?

BDC is Blue Cross/Blue Shield speak for a Blue Distinction Center, aka, their approved hospitals for specialty surgeries of which WLS is one.  

I'm sorry! Try talking to your surgeon's office insurance coordinator to get their take on what happened and whether it can be salvaged. For example, does the doctor operate at any other hospitals?

I feel so bad for you. BDC stands for a "Blue Distinction Hospital" for bariatric surgery. Is there a different hospital you can go to? Maybe research online if there are any centers near you? It seems like the surgeons office would know that though. I'd call them first to see if they can clear it up. Sorry you are going through this. 

I am so sorry this happen to you. Seriously, they rejected your choice but didn't offer to help?  Get on the phone and or if you can get your HR person to call and don't hang up until they give you a list of BDC facilities in your area.  Where were you going to have the surgery OH or IL?

Illinois.

I go to college in Ohio, but am an Illinois resident. I moved back home this semester because I thought I was getting my surgery this spring.

Thanks 

Here is the BDC Finder page on their website. It looks like there are 4 BDCs in IL. https://www.bcbs.com/blue-distinction-center-finder

If your surgeon can't get it straightened out, you'll need to find one that does surgery at one of those hospitals. Make sure not to lose any continuity on your 6 month supervised diet - have your primary care doctor continue to chart your weight if you change surgeons (or the new surgeon. Just don't skip a month).

UHC (United Health Care) also requires that you use certain hospitals.  I had gone to an information session at a local hospital and the told me they took UHC, but when I called UHC, they said only at certain hospitals (their term is different - might be Center of Excellence or something like that).  I had to change, but my supervised weight loss was done by my PCP so it carried cover, so definitely makes sure there is no break there while you work this out.  Also my weight loss center recently took a lot of patients part way through the process after another center lost the designation - they didn't make the people repeat steps, so hopefully if you have to change, this will be the case for you as well.

I have BCBS of MN and needed to have surgery at a BDC. Luckily my surgeon operated at 2 hospitals, one qualified one didn't, so I just chose the one that qualified.

Keep searching and don't give up. Your surgeon may have a referral relationship with another surgeon in your area that operates at a BDC so you won't have to start over.

As others said, you should still be able to get your surgery, but you might have to pick a surgeon that works with one of Blue Cross's approved hospitals. The good news is that you are covered though.

Contact your surgeon's office first, and see if they can straighten this out. They may have a fix. But whatever you do, don't go forward with surgery until you have it approved, in writing, from your insurance company.

This is just a bump. It will still work out if you keep after it.

Oh I'm so sorry this happened! All is NOT lost! You just have a little more work to do. My surgeon operates a 3 or 4 different hospitals. Call your surgeons office and find out if he operates at different hospitals. If not, find another Surgeon. This is still possible! Don't give up!