View Full Version : Surgery not approved

03-25-2010, 06:42 PM
I have BCBS Federal for insurance and recently my hubby called them asking how come we were receiving notices in the mail from BCBS that said my surgery was not approved and therefore BCBS would not be paying for anything, including the bone graft. Now, of course, that didn't too much for my husband's high blood pressure and we're still dealing with insurance because of this. I just had to vent here! Since when does an insurance company get to say what a doctor has "already done" is not medically necessary or the insurance company is not going to cover what the doctor has already done because the insurance company feels the doctor didn't "have" to do the surgery that way. Give me a break! Good grief. Just curious if anyone else had run into anything similar to this after their surgery was done.
Thanks - appreciate your input here.

loves to skate
03-25-2010, 07:51 PM

How horrible, but now you need to take a deep breath and then appeal. Your insurance policy has an appeal policy and you will be able to enlist your Doctor to help you with the appeal process. I am so sorry this has happened to you because who needs the aggravation, but don't give up. Giving up is what the insurance company is hoping you will do. It will all work out for you eventually.:eek:


03-25-2010, 07:56 PM
Didn't your insurance pre-approve the surgery? I cannot imagine that the hospital and surgeon would have done the surgery without first obtaining a pre-approval. You should contact the hospital's patient accounts department and ask them why you are receiving these notices.

I'm hoping that it's a mistake and everything is fine.

03-25-2010, 08:51 PM
How horrible! I cannot imagine. For those of you who have not had surgery, I have already planned to get preapproval. Insurance companies cannot be trusted!

03-25-2010, 10:37 PM
When my surgery was scheduled for March 11, I received a letter in the mail stating exactly what what surgeon had told BCBS he had planned to do during the surgery. The letter stated that the surgery was approved.

I am figuring that once a new surgical date has been picked , I will receive a new letter with the new date on it approving the surgery .


03-26-2010, 05:20 AM
Hi Rita
i didnt have scoli surgery...but years ago, i did have thousands and thousands of dollars of home care & meds...and then the nursing company changed hands and the new owners came after me...when the previous owners had promised to take whatever my insurance company allowed...i published letters, carbon copied everywhere to patient groups and newpapers...it embarrassed the new owners into dropping it and actually apologizing to me for the harrassment! they didnt want the bad publicity! dont know if that would help you any in your case...

also...can you get any help from your congressional representatives...local or national?

best of luck...

03-26-2010, 11:45 AM
Now,after I posted that yesterday, my husband got a phone call and it was BCBS, go figure. They had made a mistake - my surgery was preapproved by my doctor's office - but BCBS was not going to pay much. I'm going to let my hubby deal with this. He's a real go-getter and I don't think BCBS know who they're dealing with. He will not take this sitting down. I love this man with all my heart!!!! I think it's BCBS way of trying to get outta paying something that they know is going to be expensivde.

03-26-2010, 01:08 PM

I had to file a complaint against BCBS 20 years ago with the insurance commisioner of the state of Nevada.

They are the insurance "police" of each state.

I must say, it worked well. LOL


03-26-2010, 03:15 PM
Thanks Ed. Nice to hear. I may have to go that avenue.

03-26-2010, 05:13 PM
I was lucky, my doctor's office took care of all the billing and approval. They told me not too worry about anything and that I have enough to worry about in preparing for surgery. Something did get denied, but doctor's office said not too worry and it was just symantics. I just received the bill for the hospital today!!! I can't believe the cost!!!!!


03-26-2010, 06:38 PM
Oh Rita,

I briefly read a few responses, and I see that you were given good advice. All I can say is APPEAL, APPEAL, APPEAL. Those stinky insurance companies try to get away with all they can.

03-26-2010, 07:43 PM
I agree totally. I told my hubby not to let it upset him because we were going to appeal all that is not approved anyways. After all, it's not like a doctor is going to do surgery on someone who is not approved. And, if the insurance company can make a mistake about saying someone is not approved (ugh!) I'm sure they've made other mistakes.....imagine that.

03-27-2010, 10:51 AM
All I can say is that insurance companies are in the MONEY MAKING business!! My insurance wouldn't even approve me to get my 5 year checkup. I had to appeal it twice, once in person in front of the insurance board only to be rejected. They told me to go to "their" doctor who happens to be the head of neurosurgery at our hospital here (and it's a very good hospital - in the top 100). He was SOOO nice. He flat out told me that neither he or the hospital had the capability to help me and gave me the referral. The insurance company then had the gaul to say they wouldn't cover the x-rays. What?! What good is a scoliosis consult if you are not allowed to have an x-ray? We got that cleared up. But they are going to fight me all the way. Like someone else mentioned here, they are hoping that you just give up.

I had an insurance when I had my last son. I had horrible pre-term labor the whole pregnancy. My doctor wanted them to set me up with a home monitoring system that could track my contractions from home at a cost of abougt $100/day. The insurance company said "NO WAY". So my doctor said, "Okay, I'm admitting her to the hospital for the duration of her pregnancy (I was about 26 weeks along)." What do you know, I had a home monitor within about 2 days.

My point being, don't give up the fight, and there is a lot the doctors can do, even after the fact. It makes me mad, though, that the doctors have to waste their precious time fighting with stupid, greedy insurance companies instead of taking care of their patients the way we should be cared for. Imagine, you could probably get your surgeries right away if the doctor didn't have to sit at his/her desk writing letters and making threats just so we can get the care we need.

I think insurance is the biggest scam out there. It's too bad we need it. My husband and I thought about just cancelling our and putting the "premiums" into a savings account. The trouble is, that my scoliosis surgery will cost so much that it would be nearly impossible to save enough money to even make payments on it.

I hope you get this resolved quickly. Don't the stupid insurance companies know that putting you under this kind of stress slows your healing time and can cause other very expensive complications?!!:mad:

Sorry for venting, but I can relate. Have a great day!;)

03-27-2010, 11:02 AM
I don'gt think insurance companies feel one bit bad about slowing our healing time. They're in it for the money - and that's all. Further more, I think they truly think this surgery is cosmetic and not medically necessary at all. I do not have a good word for insurance companies either! Thanks so much for your words of encouragement. You're the BEST!

03-27-2010, 10:53 PM
Rita--Hope you are continuing to heal. Sounds like you are right on track. Sorry about this insurance problem. I would sure check with the doctor's office too. They were pretty good about coordinating those things, I think. I don't know my husband did all that. If there were problems those first few weeks, I probably was too out of it to know! Janet

03-28-2010, 12:00 AM
i dont know if it would work with your company, but most of them do not like negative publicity...in addition to shaming the nursing company into paying for meds i was promised...2 winters ago, my insurance company didnt want to cover my husband's trip to the hospital for a bad case of flu...with a high fever...at the time, he hadnt yet picked his G.P., cause several in area he chose werent taking new patients...soooo...we wrote a letter to the insurance company, copied to AARP and a few other places, protesting how dangerous flu can be to people in their 50's and 60's...BINGO...sure enuf, the insurance company changed their mind & paid for the hospital trip!!

there are all kind sof ways to get to insurance companies, besides the appeals process!

good luck


03-28-2010, 10:54 AM
Rita, I am so sorry about all this. I really hope everything gets resolve. You have to focus on your healing right now!!!
I wanted to ask you about your surgery. I can relate cause I have a 95 thoracic as well, so I am interested in how much correction you got and how long is your fusion. Do you have a rib hump, now?
I still can't get my surgery done brcause of lack of insurance. :(
I am praying this reform...