Bluecross insurance coverage

[TallTexan]

I have been fighting with BCBS insurance about paying for my implant. I had PC 8 years ago and had radiation and then of course ED. I tried pills and shots with little success. I made an appointment with implant surgeon who also was my ED doc to have implant done. The business office at the hospital took my insurance information and scheduled the implant. Now BCBS refuses to pay for the surgery . Anyone else have to deal with this kind of thing? The hospital and the surgeon are on the approved list.

[dg_moore]

I have had insurance coverage under several different employers over the years. In each case, the coverage and exclusions were dictated by the employer, not the insurance company. If you are in a similar situation it may be that BCBS is denying coverage because your company, and not BCBS, excludes implants. This can probably be appealed and might be worth investigating.

Years ago, insurance denied coverage for a bone marrow transplant for my late wife, but I came to find out that it was my employer, not the insurance company, that was denying coverage. I appealed and they finally approved the procedure, which unfortunately was unsuccessful, but that's a different story.

[radiodec]

dg is right on with one of the possible sources of being declined. If you look at the business name and similar of many Blue Cross coverages, you will find that many are just administrators, working for whomever funds the plan and that as we all know is who makes the rules.

My Blue Cross coverage, funded by my company, no longer covers the revision that I need. This is interesting in that they covered the original implant in 2012.

David

[TallTexan]

if the business office at the hospital checked on my insurance coverage before the surgery and I insisted on it being covered wouldn't they have know whether it was covered before the implant was performed. Shouldn't it have been pre approved before it was done? Something smells fishy.

[Bigred]

I didn't have Blue Cross but my surgeon's office had everything approved in writing from United Health Care before I made my appointment. I was very worried about the same thing that happened to you.
Don't give up, keep fighting. If you end up having to pay, try to work a deal with the hospital since they should accept at least part of the blame.

[radiodec]

Depending on the Blue Cross administrators policies, they very often to not preauthorize what is now considered outpatient surgery. I has become quite difficult to get an authorization from them ahead of time, only after the fact.

If it is BCBS through your company, you will probably have to go through the employee benefits manual to see what is covered and what is not.

David