This is a follow up to my thread from about a month ago: https://www.reddit.com/r/HealthInsurance/comments/lcrd0g/bcbs_not_covering_female_sterilization_after/
So I finally heard back from BCBSNC after a month. It took them the full 30 days to go through my appeal and postmark it back to me. Awesome. I had called them on the 30 day mark and got wind of what was coming, but was waiting for the actual paperwork to be in my hands before I continued with any more phone calls.
I had inquired why they were not covering my surgery in its entirety, and used resources from CoverHer, as well as print-outs from their own handbooks and the ACA regarding the fact that the procedure I had, was to be covered – and I was informed by both the hospital and BCBS that it was going to be covered in its entirety.
The response reads:
“Based on all pertinent information received and reviewed, Blue Cross NC has determined that the application of benefits to the in-network deductible and coinsurance was correct for the Tubal Ligation facility claim on November 11, 2020. You stated the procedure code 58670 and diagnosis code Z30.2 are preventive codes, which is correct. These codes on the facility claim processed at 100%. The other procedure codes on the claim are not preventive codes, which is why they processed towards your deductible and coinsurance. For the claim to fully process as preventive, all codes must be preventive codes. The claim processed correctly based on how it was filed. Therefore, your appeal has been upheld.”
When I called them on the 18th, I was told to try to convince the hospital to re-file the codes as something the insurance company would consider to be preventive. Considering it was late enough, I sent an email to the hospital.
I sent: I just got off the phone with Blue Cross Blue Shield of North Carolina regarding the appeal for my surgery that was held at the [hospital] facility on 11/11/2020. As was the initial guess back in December, the hospital did not code the injections for my surgery correctly. BCBS needs [hospital] to file any codes for the facility costs/medications as something it considers ‘preventive’ — whatever that entails.
Every single time I have reached out to [hospital] regarding this, you have insisted the codes for the actual surgery (58670) and Diagnostic (Z30.2) are correct. They ARE correct, yes. However, this is explicitly regarding everything else that was coded on that bill to my insurance company.
And got in response: I was wondering if BCBS has requested an updated copy of you billing I would advise an updated request in the event what they have now is different than what was done originally
I sent two other messages — one on the 18th and one Monday afternoon, and MyChart says neither has been looked at by staff.
I’m planning on having a 3-way call — getting BCBSNC on the phone, and then calling the hospital tomorrow. I don’t understand how or why medication for this surgery isn’t covered as just a matter of fact. Are they implying I should had went without pain medication and anesthesia for this?
0370 (Anesthesia), J3010 (Injection, Fentanyl Citrate), J0330 (Injection, Succinylcholine Chloride), J2250 (Injection, Midazolam Hydrochloride), J1100 (Injection, Dexamethosone Sodium Phosophate), J1885 (Injection, Ketorolac Tromethamine), J2704 (Injection, Propofol), J2405 (Injectiokn, Ondansetron Hydrochloride), J2550 (Injection, Promethazine HCL), J2710 (Injection, Neostigmine Methylsulfate), J7120 (Ringers Lactate Infusion), 0710 (recovery room).
I’ve contacted my own doctor’s billing office, and she is absolutely floored by how far BCBSNC has dropped the ball. I’m kind of done with the whole needing to ferry information between the two companies, but I can’t let it go. I cannot afford this $5,700 bill that was dropped in my lap because someone else has failed to do their job correctly. I ruminate way too much and don’t have a lot of people to really talk to this issue about, and after 4 months, I’m starting to lose my mind about it and that’s why I’m here looking for any bit of advice from you guys. :c
submitted by /u/Dreamscarred
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This is a follow up to my thread from about a month ago: https://www.reddit.com/r/HealthInsurance/comments/lcrd0g/bcbs_not_covering_female_sterilization_after/ So I finally heard back from BCBSNC after a month. It took them the full 30 days to go through my appeal and postmark it back to me. Awesome. I had called them on the 30 day mark and got wind of what was coming, but was waiting for the actual paperwork to be in my hands before I continued with any more phone calls. I had inquired why they were not covering my surgery in its entirety, and used resources from CoverHer, as well as print-outs from their own handbooks and the ACA regarding the fact that the procedure I had, was to be covered – and I was informed by both the hospital and BCBS that it was going to be covered in its entirety. The response reads:”Based on all pertinent information received and reviewed, Blue Cross NC has determined that the application of benefits to the in-network deductible and coinsurance was correct for the Tubal Ligation facility claim on November 11, 2020. You stated the procedure code 58670 and diagnosis code Z30.2 are preventive codes, which is correct. These codes on the facility claim processed at 100%. The other procedure codes on the claim are not preventive codes, which is why they processed towards your deductible and coinsurance. For the claim to fully process as preventive, all codes must be preventive codes. The claim processed correctly based on how it was filed. Therefore, your appeal has been upheld.” When I called them on the 18th, I was told to try to convince the hospital to re-file the codes as something the insurance company would consider to be preventive. Considering it was late enough, I sent an email to the hospital. I sent: I just got off the phone with Blue Cross Blue Shield of North Carolina regarding the appeal for my surgery that was held at the [hospital] facility on 11/11/2020. As was the initial guess back in December, the hospital did not code the injections for my surgery correctly. BCBS needs [hospital] to file any codes for the facility costs/medications as something it considers ‘preventive’ — whatever that entails. Every single time I have reached out to [hospital] regarding this, you have insisted the codes for the actual surgery (58670) and Diagnostic (Z30.2) are correct. They ARE correct, yes. However, this is explicitly regarding everything else that was coded on that bill to my insurance company. And got in response: I was wondering if BCBS has requested an updated copy of you billing I would advise an updated request in the event what they have now is different than what was done originally I sent two other messages — one on the 18th and one Monday afternoon, and MyChart says neither has been looked at by staff. I’m planning on having a 3-way call — getting BCBSNC on the phone, and then calling the hospital tomorrow. I don’t understand how or why medication for this surgery isn’t covered as just a matter of fact. Are they implying I should had went without pain medication and anesthesia for this? 0370 (Anesthesia), J3010 (Injection, Fentanyl Citrate), J0330 (Injection, Succinylcholine Chloride), J2250 (Injection, Midazolam Hydrochloride), J1100 (Injection, Dexamethosone Sodium Phosophate), J1885 (Injection, Ketorolac Tromethamine), J2704 (Injection, Propofol), J2405 (Injectiokn, Ondansetron Hydrochloride), J2550 (Injection, Promethazine HCL), J2710 (Injection, Neostigmine Methylsulfate), J7120 (Ringers Lactate Infusion), 0710 (recovery room). I’ve contacted my own doctor’s billing office, and she is absolutely floored by how far BCBSNC has dropped the ball. I’m kind of done with the whole needing to ferry information between the two companies, but I can’t let it go. I cannot afford this $5,700 bill that was dropped in my lap because someone else has failed to do their job correctly. I ruminate way too much and don’t have a lot of people to really talk to this issue about, and after 4 months, I’m starting to lose my mind about it and that’s why I’m here looking for any bit of advice from you guys. :c
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