Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Anthem denied claim after surgery completed



Recommended Posts

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.

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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 :)

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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. 👍

Share this post


Link to post
Share on other sites

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 by StratusPhr

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×