I Don't Understand Fully What's Happening Or What Happens Next...

[Comfy_Blue 285]

I live in Maryland and have Care First BCBS.

Yesterday morning my surgeon's RN called and said she was submitting my documents (ie: psych eval, clearance by primary care physician, proof of weight watchers, sleep study results, etc) to my insurance company where another RN would approve or reject me.

This morning my surgeon's RN called me back and said the insurance company's RN contacted her and said that I had been approved for a procedure date of Dec. 23.

I am obviously excited, but a little confused. Does that mean I am definately, 100% having my surgery, or is it possible that the BCBS nurse approves me and submits me to the insurance company and they reject me?

I asked my surgeon's RN and she said that nothing is guareenteed when it comes to an insurance company. I don't know what to think.

Has anyone ever been approved by their insurance company's RN, then rejected by the insurance company itself for a procedure?

Am I going to receive a letter in the mail from CF BCBS? Is the BCBS RN the one who decides whether or not I will have surgery and since she approved, does that mean I am done waiting for approval?

[Sue Magoo 71]

Usually an insurance company has an authorization number for a procedure that 's been approved. Ask your surgeon's office for the authorization number and also ask them to scan the authorization document that they have to you for your records.

Another thing you could do is contact your insurance provider and ask them for the same document. There's usually a phone number on your insurance card that you can contact. I know with my insurance I can look up procedures online and when I was authorized for my lapband removal I could see the authorization there.

Good luck!

Sue

[Comfy_Blue 285]

thank you sue! i looked on my company's website and i didn't see this claim on my list of claims (instead i say things like my psych eval, my sleep study, my lab reports, etc). Maybe it takes them 24 hours to load it. If I don't see it tomorrow morning I'm going to follow your advice and ask.

[Sue Magoo 71]

It won't be a claim until someone (hospital or surgeon, etc.) makes a charge against the procedure. So, wherever it was that you saw those claims see if there's something there about authorizations or procedures. You may find your authorization number there.

Sounds like you're very close and if December 23rd is your date, you're going into the new year being a healthier you. Congrats!

Good luck!

Sue