As the title implies, my secondary insurance denied my claim from my surgeon, but approved the same exact claim (same surgery- jaw surgery; same exact CPT codes) from the assistant surgeon. They allegedly claimed that it was not rendered as “medically necessary”. How is it medically necessary for the assistant surgeon’s claim (again, same exact CPT codes, same patient, same surgery procedures, same pre-operative, operative and post-operative documents). This makes NO SENSE! I have never heard of an instance. Naturally, I called the insurance company and spoke to a Supervisor, because everyone is baffled! What could be the worst case scenario here???
For reference, I live in NJ and have Horizon BCBS. It was pre-authorized for medical necessity, and they paid their portion according to my benefits. My Secondary Insurance is Emblem Health (GHI) through NYC; this is the insurance that has denied my surgeon’s claim but approved the assistant surgeon’s.
submitted by /u/StruggleIsMotivation
[link] [comments]
As the title implies, my secondary insurance denied my claim from my surgeon, but approved the same exact claim (same surgery- jaw surgery; same exact CPT codes) from the assistant surgeon. They allegedly claimed that it was not rendered as “medically necessary”. How is it medically necessary for the assistant surgeon’s claim (again, same exact CPT codes, same patient, same surgery procedures, same pre-operative, operative and post-operative documents). This makes NO SENSE! I have never heard of an instance. Naturally, I called the insurance company and spoke to a Supervisor, because everyone is baffled! What could be the worst case scenario here??? For reference, I live in NJ and have Horizon BCBS. It was pre-authorized for medical necessity, and they paid their portion according to my benefits. My Secondary Insurance is Emblem Health (GHI) through NYC; this is the insurance that has denied my surgeon’s claim but approved the assistant surgeon’s.
submitted by /u/StruggleIsMotivation [link] [comments]Read Morer/HealthInsurance