I got all of my approvals pre-op, had surgery 3 weeks ago tomorrow, and last night my insurance company website updated my claim (just a few dollars short of $11,000) as DENIED.

I've tried to call them 3 times today and sat on hold so long I had to hang up, because I'm at work and I've got a lot of meetings on Mondays. No idea what fresh hell is being perpetrated here, but my left eyelid is twitching.

Hopefully you and your surgeon have that approval in writing somewhere. The surgeon and the insurance co-ordinator in that practice will no doubt be your best allies in approaching an appeal. My insurance (BCBS Federal Employee) sent me a document stating that I was approved for the surgery and up to five days in the hospital. I sent a copy of that to my surgeon so that they had it in addition to whatever BCBS sent them. I am sure that your surgeon would not have performed the operation if approval was in doubt. Take a deep breath and don't send anyone any money yet. It could just be that the left hand does not know what the right hand is doing.

@@roundisashape Oh dear! I will have BCBS of AZ effective 1-1-15, and have done everything I can so far to be ready for my dr's office to submit on 1-2-15 -- I've self-paid for some pre-op visits, etc, just to be ready for insurance effective date. Who was your surgeon, if I can ask? Mine is Dr. Swain at Scottsdale Healthcare -- best of luck and keep us informed!!

We're kind of weird - I work in Maryland for a Canadian company, but they got us BCBS AZ. I have no idea how that works, lol.

I saw a new claim come through as "pending" this afternoon for the actual procedure. I don't know if things just came through in the wrong order or what, but I'll definitely update as soon as I find out what's going on.

I do have all the paperwork though, for sure! Both the approval letter, and the letter with the date on it.

LOL, we're in AZ, but had BCBS of Illinois - but switching to BCBS of AZ -- go figure ) Sounds like it was a 'crossed in the mail' issue for you -- hope so!

::banghead::

They published the explanation of benefits. Denied because the service wasn't provided at a Blue Distinction Center.

I went to their website and took a screen shot showing that Hopkins Bayview IS a Blue Distinction Center and emailed that to customer service. We'll see what happens.

FINALLY! The insurance company is reprocessing. Of course, I got the actual bill today so the clock is ticking.