My insurance denied the implant surgery

[Witheringhog]

Clavell and his team did everything for me, it was all behind the scenes.

[macattack]

Thanks for all the encouragement as I keep fighting to get this approved.

[Phndoc]

This is one of the surgeries that has to be pre-approved. If, the doctor didn't use the right codes. The surgery will be denied. I also, have Athem in Virginia. I talked to them about this and was told that the codes of to be correct to get the approval. This is the reason my surgery is at the end of March. So, that everything can be worked out before hand.

[Phndoc]

I just got my approval letter from my insurance. So, I am good to go. Hopefully, your doctor will get everything to pass.

[SCOOTER12]

My insurance denied my first authorization too. They just have to resubmit it with different codes and reasons.

I just saw that my doctor submitted a claim for $100k for my implant. That was just the surgeons part. Good money in this biz.

[macattack]

So after resubmission and appeals my insurance says that it remains denied due to exclusions. My wife starts a new job in March and I’m going to investigate if her coverage will be better. Needless to say I’ve been bummed about the whole delay. But it will happen at some point.

[Gt1956]

My insurance denied my first authorization too. They just have to resubmit it with different codes and reasons.

I just saw that my doctor submitted a claim for $100k for my implant. That was just the surgeons part. Good money in this biz.

Don't be fooled by what he billed. He'll only get whatever the pre negotiated rate is. Most reasonable guesses puts that around the cash pay price for that particular area.

[Phndoc]

I have Anthem through my employer in Virginia. I was scheduled to receive the implant on 1/23 but now it’s on hold. The authorization department states it’s not covered. The benefits department states that it is. I’ve started an appeal process but due to scheduling I am probably delayed at least a month. I was just getting over the nervousness of it all! Any advice out there? I’ve started the appeals process and am unsure of what else to do. Thanks!

I have the same insurance. When I spoke with Anthem, I was told that it all has to do with the codes that are used. My doctors here in Virginia Beach was able to get me approved for the implant.

Please keep up the fight. Maybe reach out to the insurance company if, you haven't already and asked them why or what codes should be used.