Surgery on Tuesday NOT APPROVED by BC BS

[Day_Dreamer]

I thought I was scheduled for Deviated Septum surgery on Tuesday

I just get a call NOW that my insurance did not approve it

Dr. Park is putting in an "override" but that seems to require departmental approval and I am not sure I'll get it

Any ideas what's going on??

The surgical scheduler had little info

Suggestions ?

Thanks

[Julie]

Why haven't you called your insce. co? Only they can tell you the reason they denied it.

[Paralel]

For certain surgeries/procedures insurances have very specific requirements, condition has to be a certain severity, trying and failing other therapies first, etc... You need to contact your insurance company for more information.

[Wulfman...]

Did they get the insurance billing/diagnosis code(s) wrong?


Den

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[Sclark08]

BCBS paid for my deviated septum. I would call them. Drs office probably coded it incorrectly. It happens all the time.

[chunkyfrog]

BCBS is "good" at that. I bet they pay cash incentives for major clusters.

[webbie73]

For certain surgeries/procedures insurances have very specific requirements, condition has to be a certain severity, trying and failing other therapies first, etc... You need to contact your insurance company for more information.

When I went to the ENT about my deviated septum we agreed surgery was the way to go. He then smile and prescribed a nasal spray to prove to the insurance company that I failed other therapies. One month later my surgery was scheduled. Now I can breath through a nose that had been blocked for years. It also has helped with my daily AHI.

[49er]

For certain surgeries/procedures insurances have very specific requirements, condition has to be a certain severity, trying and failing other therapies first, etc... You need to contact your insurance company for more information.

When I went to the ENT about my deviated septum we agreed surgery was the way to go. He then smile and prescribed a nasal spray to prove to the insurance company that I failed other therapies. One month later my surgery was scheduled. Now I can breath through a nose that had been blocked for years. It also has helped with my daily AHI.

The ENT I saw on Thursday, prescribed one for the same reason. I see him in three weeks for a followup.

Day Dreamer, I hope you get your situation resolved because I am sure it is very frustrating to prepare yourself for surgery only to find it is cancelled hopefully just temporarily.

[Wulfman...]

Maybe Dr. Park is not "in-network".


Den

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[Paralel]

Maybe Dr. Park is not "in-network".


Den

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In vs. out of network generally doesn't matter if the person has PPO or FfS type of insurance coverage, just the amount the insurance pays will differ. If the person is part of an HMO they can indeed deny coverage if the doctor is out of network unless certain criteria are met in advance, and it usually involves certified documentation from a in-network physician that no in-network physicians are capable of adequately performing the procedure, and pre-auth is also needed.