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DENIED!

AnonymousUserAAnonymousUser Posts: 49,899
edited 06/11/2012 - 8:25 AM in New Member Introductions
If anyone can provide answers please let me know...

I first was given the ok for surgery November 5th with my date of surgery November 18th. I was told this was the date as long as surgery was approved by the insurance. The dr's office told me with Anthem BC & BS they usually deny claims before approving them. That they are very hard to work with and this was very routine. They had denied my claim last week so my dr's office immediately appealed it. Today they had a phone conference with my dr. and the insurance dr. and he again denied the claim which has to go for ANOTHER appeal. The insurance claims lady at the dr.'s office says that the 2nd appeal usually takes longer than the first and I probably will not have my surgery on the 18th. Has anyone had this happen if so how long usually does it take for you to get this back? Also, what is my next step if they deny again? No surgery? This is crazy!! The reason I am stressing so much is that I am a teacher and they have already gotten my sub for while I am gone and now I'm going to have to push the date and I don't know if that GOOD substitute will wait on me to figure out what I'm doing or look for another sub job.

Help....anyone with answers. Thanks so much!!!
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Comments

  • a look at the insurance section of this forum. There have been lots of folks there that have the Anthem BC/BS. I am sure that they posted the way to get approval. If it is not on this new forum, try and search the old forum (archived threads) I am positive there were several folks with your same insurance and the same issues. Good luck and keep us posted.
  • The insurace is still denying my claim. I just got another MRI yesterday per my NS he is hoping this helps in the appeal. I am in a waiting game right now. Has anyone gone through this? If so any suggestions? ~X(
  • i am sorry to hear of your insurance troubles. i don't have your type of insurance carrier and i hope you reach a solution and they keep your surgery date. i think now of days problems with health insurance claims and pre authorizations is common with them all. my insurance has denied certain procedures and precriptions that specialist doctors have requested just the other day and also in the past. nothing like what u are going through. i wish u the best and i will also pray for u.
  • teacher- sorry to hear of the ins problems but hopefully the dr is familiar with the appeal procedures and will help speed up the process. I hope the new MRI will help get the approval. Sadly the ins co can block a drs treatment plan and just keep fighting with help of the dr. Sadly, it almost seems some ins cos tell the dr how to treat the patient when they have never seen that person and have no idea of the problems...jade
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