Question:
I was approved by BCBS, now after the surgery they have denied my claim

I am really freaked out over this. I had the surgery because I was approved. Now I am getting the bills back stating that my claim is denied due to exclusion of weight loss surgery. They knew this before, I jumped through the hoops. Why? And what should I do now?    — Belinda R. (posted on January 6, 2004)

January 6, 2004
If your surgeon submitted the claim I would let them handle it. It very well could be the wrong coding. Don't worry at this point. Call your surgeons office and ask them what is up.
   — TheresaC

January 6, 2004
I hate to be negative but I have had my share of battles with BCBS. I had a consultation for infertility approved only to be later told we did not give you the ok to see the dr, However, I ws only able to gt\et the name of the doctor FROM BCBS after being aproved. That case now sits on my credit report. I have not applied for approval for my surgery yet but if they approve me and I get the surgery and then they deny my clame I will say, "Who cares" it's done! Keep your head up. Ypu got the surgery, that's that's what counts!
   — Jeanette O.

January 6, 2004
Did you get the letter that you were pre-qualified from Blue Cross? Blue Cross requires you to pre-qualify. Also, I received bills from the anetylogist after my surgery that were rejected because they were not covered. When I called Blue Cross, I was told it was covered but the anetylogist doctor filled the claim incorrectly.
   — jcooper

January 6, 2004
Hello. The same thing happened to me. I had surgery on Sept. 3, 03. My surgeons office said not to pay anything yet, they are working on getting it paid. They have to resend all my information. So I am still waiting.
   — AmyWollet

January 6, 2004
I had the same problem with BCBS after I had my WLS. I got all the documentation together, including my letters of pre-authorization, and approval. I called the Drs office and had them fax me the letters, so I had their copies, plus the copy they sent me. After I had all that together, I recieved a statement stating that they did pay. I would have fought it, because they paid for everything else, asst surgeon, anesthesiologist (bad spelling), all my pre-surgical testing. Just get all your papers together, so if they do decide that they are actually going to give you a hard time, you have documentation stating that it was approved. Good luck to you RNY 5/15/03 down 106Lbs. :-)
   — KellyJeanB

January 6, 2004
I had the same problem with my ins...But the problem was the billers at the Hospital. they coded the diagnosis wrong..They used 278.00 Obesity instead of 278.01 MORBID obesity......It could be coded incorrectly.
   — Missileman

January 6, 2004
I agree with the other posters that said they had this happen to them as well... fortunately for me I had a copy of the letter which approved the surgery. It was a coding issue... and now, as of just about 6 months (and many phone calls!) after the surgery, it appears BCBS is paying the 90% they are supposed to... keep on them, don't give up!
   — Tim W.

January 6, 2004
All you need to do is call the insurance company. They will have it documented that the surgery was approved. They will then re-process your claims.
   — Patty H.

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