BCN Didn't Pay

After two written appeals and a face to face appeal, and having an approval letter....BCN declined to pay for my surgery. At first I thought it was a mistake but then I got a bill from the hospital for $26,400.00!!  Insurance payment $0.00!! That doesn't even include the doctors fees. Boy I can't wait until Monday.  I'm going to be making a lot of calls and raising some hell. Anybody have this happen to them? Joni

Easy for me to say but take a deep breath and think out your strategy. If you make them mad then they will blow you off. Stay calm and just make it happen. Think clear and concise. Make them work for you. kp

Joni: I agree with kp.  Stay calm and be methodical about getting to the bottom of the situation.  If you go in like a man woman and raise hell you're just going to **** people off and alienate them.  You can catch more flies with honey, remember. I think your first move needs to be to find out WHO approved the surgery in the first place.  A surgeon's office wouldn't move forward with a surgery unless they had approval for payment beforehand.  At least, not a surgeon with any brains, anyway.  Did someone in his office just "assume" that BCN would approve?  If so, who was it?  What's the paper trail for how that decision got made?  Do you have a paper trail or journal of the calls and contacts you had with BCN throughout the process of approval?  Were you told it was a covered benefit by someone?  Who?  When?  Were you given a list of qualifications that you needed to meet?  Do you have proof that all those requirements were actually met?  Make sure you have copies of all the paperwork that was sent to the insurance company if you don't have that already.  Be strategic and thorough about every step you take. When were the appeals?  Before surgery or after?  Seems like your "approval letter" is going to have a lot of weight in a legal case if it gets to that.  Might be worth talking to a lawyer.  (There's a good one here on OH over on the Insurance forums.) Do you have someone in your HR department at work that can help you work through this process and add their wait to the investigation?   I'm sorry you're going through this.  But it sounds like something that you can fight and keep fighting until you get to the correct answers.  Keep your chin up and stay calm.  Things WILL work out. Pam

This happens a lot with bcn.    Call your surgeons office and ask for a copy of the referral.    Next call bcn and let them know you have the referral and copy  of the approval letter.   You will probably just have to fax it to them and that will take care of it all.    From now on make sure you get a copy of every referral you get.   You have to stay on top of it all with bcn.    Let me know how it works out. Linda

1-2-3-4-5 okay I thought maybe that would help you take a deep breath. I agree find out who approved the surgery. Then go at that with full throtle.  Maybe just maybe a computer error was made. Or someone running the darn thing put in a wrong code.......thats happened to me before. Just hang in there it'll work out!!     Good luck on Monday! B