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Anthem denied claim after surgery completed



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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.

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

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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!

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

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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.

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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!

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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!

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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 :)

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

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