Questions on insurance coverage of pre-op procedures

Dukemom
on 10/26/13 12:13 pm
RNY on 12/17/13

I know I need to talk to my insurance company Monday, but I wonder if this has happened to anyone else.

Mayo's policy it to have 2 rounds of exams and evaluations before they submit the letter for authorization.  I know from talking with my insurance company the surgery will be covered.  I also checked on all the codes Mayo uses for the pre-op testings and they were all approved by my insurance company.

I received my latest Explanation of Benefits today.  BC/BS did not cover any of the pre-op exams or evaluations; they said they weren't covered.  All my pre-op blood work was covered because it was coded as something cardiac related.

My suspicion is that the visits aren't covered because the surgery hasn't been approved.  Heck, the letter for approval hasn't even gone in yet.  I'm praying that once the surgery is approved (I am an optimist), that they will cover all the appointments they have refused.

Anything similar happen to anyone else?  What was the outcome?

Thanks in advance.

"Perseverance, secret of all triumphs."  ~ Victor Hugo   

  Highest weight:  290; Weight at Surgery:  231; Current Weight:  126 (as of most recent Sunday)

  

    

PetHairMagnet
on 10/26/13 12:30 pm
RNY on 05/13/13
I did not have those issues. But I would call the patient advocate at the insurance and see what they can share with you.

    

HW333--SW 289--GW of 160 5' 11" woman.  I only know the way I know & when you ask for input/advice, you'll get the way I've been successful through my surgeon & nutritionist. Please consult your surgeon & nutritionist for how to do it their way.  Biggest regret? Not doing this 10 years ago! Every day is better than the day before...and it was a pretty great day!

        

    

    

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