Anthem bcbs of georgia sucks

[GoodWood]

Denied me surgery on 26th.filed a grievence and a appeal to try to get them to approve.have bad venous leak and type 2 diabetes.anyone know what i need to do?im freaking devasted as im deeply depressed and now this...any help would be greatly appreciated as i dont even want to keep goin on with life..fucking ed sucks the life out of you

I had my surgery over 2 years ago, BCBS agreed to pay and didn't after the surgery. After many appeals and my paperwork going from one place to another it now sits in the hands of the Dept of Labor. My doc's office has been great and is doing everything in their power in helping me while not asking me for a dime. $45,000 on the line.

This is my nightmare. I’m scheduled for surgery on Tuesday the 25th. Having them refuse payment AFTER. OMG, that would be horrific.

[LastHope]

Aetna has a track record of faster pre-authorization approvals.Those motherfuckers can still pull the rug out from under you 48 hours before surgery. Cash pay option is much cheaper than the amount they bill to the insurance, so always get two quotes from the surgeon's billing office.

[Tuscan_Order]

I had my surgery over 2 years ago, BCBS agreed to pay and didn't after the surgery. After many appeals and my paperwork going from one place to another it now sits in the hands of the Dept of Labor.

Did BCBS provide you with documentation showing approval? Anthem BCBS just approved my surgery and sent me a link to a PDF explaining everything, listing hospitals and doctors as being "in-network" and listing the dates that the approval is good through. It's pretty cut-and-dried, and I'm not sure how they could back out without legal issues.

[Dramatic_Head8735]

Don’t give up. I was pre-approved, got my implant and was just informed they have denied the claim for $71,000. I spoke to the representative and was told they will resubmit due to the prior authorization. I also spoke to the surgeon’s office and they said they were aware and addressing the issue. Sometimes all you have to do is fight and they will find a way to fix it.

[Alex258]

I had my surgery over 2 years ago, BCBS agreed to pay and didn't after the surgery. After many appeals and my paperwork going from one place to another it now sits in the hands of the Dept of Labor.

Did BCBS provide you with documentation showing approval? Anthem BCBS just approved my surgery and sent me a link to a PDF explaining everything, listing hospitals and doctors as being "in-network" and listing the dates that the approval is good through. It's pretty cut-and-dried, and I'm not sure how they could back out without legal issues.

Yes have documentation etc. This is why everyone hates insurance companies. Hoping that the Dept of Labor fixes this.

[Asdefxx]

Cash pay option is much cheaper than the amount they bill to the insurance, so always get two quotes from the surgeon's billing office.

Can you explain this part? Are you saying that even if you try to do it through insurance but fail and ultimately end up having to pay yourself, you would only be in the hook for the cheaper cash quote, and not for the inflated insurance quote.

[LastHope]

For example, if your surgeon offers 2 options for inflatables:
1) Surgeon's clinic/office procedure (cash payment): $22,000
2) Hospital facility procedure (insurance billed): $91,000

You get a pre-authorization for option #2 and undergo surgery at the hospital. After the procedure, Aetna refuses to reimburse, leaving you responsible for the full $91,000 bill.

It's always advisable to get pre-authorization in writing and reconfirm it with the insurance as the surgery date approaches.

If Aetna sends you a letter 48 hours before surgery that it's not a medically necessary procedure, then you are better off calling the billing office ASAP and switching to Option #1.

[Chrismc1981]

No bcbs strictly denied my claim so fuck em

[Chrismc1981]

I need someone in georgia who has had this approved my there insurance to tell me what plan they have and need tbe full plan info so i can get this surgery done before this depression takes over my life for real

[LastHope]

If I lived in Georgia, I’d only trust Dr. Tariq Hakky or Dr. Charles Kaplan to cut my penis, no one else. Experience counts, not just for surgical precision but also for nailing insurance claim submissions. That said, Cigna and Aetna are still pieces of shit for this procedure according to a billing expert of a highly reputed hospital I was working with. He spoke highly of UHC, Humana, BCBS and Kaiser for penile implants. Surprised to hear BCBS doing this to you.

Some surgeons accept CareCredit.
You can find that out here:

https://www.carecredit.com/find-a-location/

They offer interest free credit for dental/cosmetic/implant surgeries for the first 12 months and a ridiculous interest rate after that. If someone can't repay that in 12 months, around 11th month, switching to a loan from a bank is a wise move.