Before I start, sorry if it’s the wrong flair.
Getting to the nitty-gritty, I had my tubes tied in November of last year, and am having trouble getting BCBSNC to fully cover the procedure. This was after it being authorized, having went through the research phase and making phone calls, and my doctor’s office making phone calls, the entire shabang to ensure that, yes. This procedure is covered by my insurance plan and will be 100% covered.
In December, I get a bill from the hospital to the tune of $5700. My deductible is $5K. I cry.
First Call to Insurance after the bill: Lady I spoke with agreed that it should be covered, and she was confused as to why it was not. My deductible shouldn’t had been applied, and I don’t owe copay or coinsurance. She sent it off to be reprocessed.
Another bill, another phonecall. This woman told me it was not being covered because apparently I had difficulties during surgery. This was news to me, as my paperwork from the surgery has a little line that states “Complications: None”. I could feel her shrug her shoulders over the phone as she told me to file an appeal.
I called my doctor’s office, who then contacted both Insurance and the (in network) hospital on my behalf. She confirmed that there were absolutely no complications, and that the procedure is 100% covered. She also confirmed the coding was correct and had them send the claim off to be reprocessed again.
Another bill comes. I called BCBSNC again. Find out that the claim sent off previously was a claim that was already 100% covered and they just sent the wrong one off for whatever reason. (Both my doctor and anesthesiologist were covered and they had sent the latter off)
This woman was actually extremely sweet and helpful. She opened up my claim and went step-by-step, finding what my plan covered and what was on the claim. She agreed that yes, it was a procedure they cover, and that for some reason processing was charging me for facility costs and the medications — both of which are required for the surgery. (It was outpatient, and I was home about 5 hours after arriving at the hospital.) She called her manager over and they both agreed it needed to be reprocessed.
So I’m sitting here a month later after the last call, with the hospital still wanting their money and BCBSNC being quiet on all fronts. I sent a message to another person on Reddit who gave me some ideas on what to do, but I thought I would come here and see if I should continue trying to work this out with insurance even though it seems to be going no where, or if I should start taking it to BBB or the state board.
I have checked and printed out sheets of paper all saying that BCBSNC covers this procedure, down to finding their big CPT code charts and seeking out my codes ( Z30.2 , 58670 ), and have been told by multiple representatives that they cover it, but the processing team just doesn’t seem to give a flying F.
The stress that this has put on me has become mentally taxing and physically noticeable. I have gotten several white hairs, this is almost all I think of at work, and have lost several pounds – a coworker mentioned I looked gaunt, which kind of made me chuckle but it is what it is. It’s hard to concentrate because I have so much anxiety, stress, and anger being fueled by this (it runs in the family). I’m hoping someone can help me out here.
submitted by /u/Dreamscarred
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Before I start, sorry if it’s the wrong flair. Getting to the nitty-gritty, I had my tubes tied in November of last year, and am having trouble getting BCBSNC to fully cover the procedure. This was after it being authorized, having went through the research phase and making phone calls, and my doctor’s office making phone calls, the entire shabang to ensure that, yes. This procedure is covered by my insurance plan and will be 100% covered. In December, I get a bill from the hospital to the tune of $5700. My deductible is $5K. I cry. First Call to Insurance after the bill: Lady I spoke with agreed that it should be covered, and she was confused as to why it was not. My deductible shouldn’t had been applied, and I don’t owe copay or coinsurance. She sent it off to be reprocessed. Another bill, another phonecall. This woman told me it was not being covered because apparently I had difficulties during surgery. This was news to me, as my paperwork from the surgery has a little line that states “Complications: None”. I could feel her shrug her shoulders over the phone as she told me to file an appeal. I called my doctor’s office, who then contacted both Insurance and the (in network) hospital on my behalf. She confirmed that there were absolutely no complications, and that the procedure is 100% covered. She also confirmed the coding was correct and had them send the claim off to be reprocessed again. Another bill comes. I called BCBSNC again. Find out that the claim sent off previously was a claim that was already 100% covered and they just sent the wrong one off for whatever reason. (Both my doctor and anesthesiologist were covered and they had sent the latter off) This woman was actually extremely sweet and helpful. She opened up my claim and went step-by-step, finding what my plan covered and what was on the claim. She agreed that yes, it was a procedure they cover, and that for some reason processing was charging me for facility costs and the medications — both of which are required for the surgery. (It was outpatient, and I was home about 5 hours after arriving at the hospital.) She called her manager over and they both agreed it needed to be reprocessed. So I’m sitting here a month later after the last call, with the hospital still wanting their money and BCBSNC being quiet on all fronts. I sent a message to another person on Reddit who gave me some ideas on what to do, but I thought I would come here and see if I should continue trying to work this out with insurance even though it seems to be going no where, or if I should start taking it to BBB or the state board. I have checked and printed out sheets of paper all saying that BCBSNC covers this procedure, down to finding their big CPT code charts and seeking out my codes ( Z30.2 , 58670 ), and have been told by multiple representatives that they cover it, but the processing team just doesn’t seem to give a flying F. The stress that this has put on me has become mentally taxing and physically noticeable. I have gotten several white hairs, this is almost all I think of at work, and have lost several pounds – a coworker mentioned I looked gaunt, which kind of made me chuckle but it is what it is. It’s hard to concentrate because I have so much anxiety, stress, and anger being fueled by this (it runs in the family). I’m hoping someone can help me out here.
submitted by /u/Dreamscarred [link] [comments]Read Morer/HealthInsurance