Adverse Determination–Texas

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We received a notice of adverse determine from BCBS of Texas today in the mail. My husband had a procedure done last Dec. Before the procedure, the dr’s office filed a prior authorization, which BCBS approved, and procedure was performed. Everything has been paid. Now, almost a year later, BCBS stated that the procedure is not medically necessary. It’s about $13k, which we definitely can’t afford to pay if it’s denied. How can they approved the PA, then reversed their decision? Any advice? Thank you!

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We received a notice of adverse determine from BCBS of Texas today in the mail. My husband had a procedure done last Dec. Before the procedure, the dr’s office filed a prior authorization, which BCBS approved, and procedure was performed. Everything has been paid. Now, almost a year later, BCBS stated that the procedure is not medically necessary. It’s about $13k, which we definitely can’t afford to pay if it’s denied. How can they approved the PA, then reversed their decision? Any advice? Thank you!
submitted by /u/LoveWeim [link] [comments]Read Morer/HealthInsurance

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