Frustrated - BCBS AZ

[roundisashape 712]

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.

[Miss Mac 6,261]

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.

[della street 213]

@@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!!

[roundisashape 712]

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.

[della street 213]

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!

[roundisashape 712]

::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.

[roundisashape 712]

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