Anthem denied claim after surgery completed

[DeeTee 3]

Hi, I was wondering if anyone has experience Anthem BCBS claim denial for the 2 day hospital stay after the R-N-Y? Surgery was paid but, they are denying the $60K “Room and Board” for the 2 day inpatient stay afterwards. Ugh... I am so sick right now! Any words of wisdom right now would be appreciated.

[minimamaz00m 61]

Did they approve "inpatient" or outpatient? I have BCBS and was approved inpatient but haven't had surgery yet.

[Jaelzion 1,123]

Definitely file an appeal and also let your surgeon's office know what's going on. They obtained pre-authorization I'm sure, so they probably have documentation that can help. It makes no sense to approve a surgery and then deny the hospital stay associated with it (two days is not an unreasonable stay for bariatric surgery). Also check with the hospital business office and let them know. There may be something wrong with how they submitted the claim. They want to get paid, so it's in their interest to help you sort this out. Sorry this is happening, it's stress you don't need. But there's a good chance that decision can be reversed. Good luck!

[DeeTee 3]

Thank you for the great feedback. I will have a busy day tomorrow making phone calls.

[Chantrella 125]

7 hours ago, DeeTee said:

Hi, I was wondering if anyone has experience Anthem BCBS claim denial for the 2 day hospital stay after the R-N-Y? Surgery was paid but, they are denying the $60K “Room and Board” for the 2 day inpatient stay afterwards. Ugh... I am so sick right now! Any words of wisdom right now would be appreciated.

Hello, was the surgery done at a blue distinction facility? My cousin got approved for surgery but hers wasn't done at a supporting facility and she was stuck with a bill for the same thing as you, but I feel that's faulty on the insurance.

[njlimmer 338]

Definitely double check w/insurance. When I had my oldest, insurance paid for the day before I had her since I went in the night before, and the day after I had her but not the day of delivery. I called, and the woman was like... hmm... it shows you didn't have insurance that day. What?? She fixed it, but that $11k bill for one day about gave me a stroke!

[Luna805 69]

On 12/16/2020 at 18:37, DeeTee said:

Hi, I was wondering if anyone has experience Anthem BCBS claim denial for the 2 day hospital stay after the R-N-Y? Surgery was paid but, they are denying the $60K “Room and Board” for the 2 day inpatient stay afterwards. Ugh... I am so sick right now! Any words of wisdom right now would be appreciated.

Ugh, how stressful! Even though you got an outrageous bill, try and remain calm and start working through out. Great advice has already been given. Call your surgeon team and let them work on this for you. Also call your insurance and ask why it was not covered. Sometimes it can be a simple paperwork error or they didn’t receive the right forms from Doctor. I have worked through hospital bills that looked like yours and it can be gut wrenching to see! But stay calm and know that it can be solved. Good luck to you and don’t stress!

[DeeTee 3]

Update: I spoke with the hospital this morning and they resubmitted the claim yesterday as they did have a pre-authorization approval from the insurance for the inpatient stay. So, now it is just sit and wait.

Thank you for your replies and as suggested I am going to try not to stress

[GradyCat 3,692]

How is that possible? Your surgeon should have included the required two-night stay as part of the approval process? Appeal it!

[enciso 1]

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Edited December 18, 2020 by enciso

[DeeTee 3]

Hi All, I wanted to thank you again for the responses and to provide an update that insurance did accept and pay the hospital stay. Feeling so blessed.

[Jaelzion 1,123]

20 hours ago, DeeTee said:

Hi All, I wanted to thank you again for the responses and to provide an update that insurance did accept and pay the hospital stay. Feeling so blessed.

Yay! Good to hear. 👍

[StratusPhr 127]

I am possibly looking at a revision from sleeve to RNY. GERD, and apparently I have a small ulcer and had a stricture. I was cash pay for the sleeve, any experience with insurance, specifically Anthem BCBS covering this if it comes to that? Thanks y'all.

Edited May 19, 2021 by StratusPhr

[Chantrella 125]

Just want to say that my hospital stay was denied after surgery even though it was approved before the hospital sent me a bill for 54,000 yes you read that right! I called anthem in shock and the guy resubmitted took 30 days but they paid it.