Stefanie S.
Well-Known Member
So a week ago, insurance (BCBS of NC) denied my surgery. I am a revision - going from sleeve to DS. They first denied because of some new rule change on Jan 1 about a 12 month requirement. My surgeon (Dr. Sudan) didn't feel that I should have been denied based on that. He had his staff resubmit. That was last Thursday. BCBS said they have until Monday at 5pm to get an answer back as it was escalated to their medical director. Surgery is supposed to be the very next day. How will that work?
I found the policy and looked it over. It does say that a 2 stage process is not covered, i.e. going from a sleeve and later to a full DS. BUT BCBS didn't pay for my sleeve. I did, out of pocket. I've been in a fog. I can't believe they let you go 6 months through ALL of that pre-op stuff. All of the time and money already spent, and then they deny you last minute.
Well, I am quite fortunate in one aspect. I have a grandfather who said he will pay for my surgery if insurance denies it. I have already flown my mom in from Kansas to be with me this week so ideally the surgery will still happen on Tuesday (24th). I only found this out from my grandpa yesterday so I have to wait until tomorrow to talk to everyone about the possibility of self-pay. My question is..... has anyone else done this? Do you think if it's paid via credit cards and cash (however that works?), that this surgery could still happen on Tuesday?
Bummed in Raleigh, NC
Stefanie
I found the policy and looked it over. It does say that a 2 stage process is not covered, i.e. going from a sleeve and later to a full DS. BUT BCBS didn't pay for my sleeve. I did, out of pocket. I've been in a fog. I can't believe they let you go 6 months through ALL of that pre-op stuff. All of the time and money already spent, and then they deny you last minute.
Well, I am quite fortunate in one aspect. I have a grandfather who said he will pay for my surgery if insurance denies it. I have already flown my mom in from Kansas to be with me this week so ideally the surgery will still happen on Tuesday (24th). I only found this out from my grandpa yesterday so I have to wait until tomorrow to talk to everyone about the possibility of self-pay. My question is..... has anyone else done this? Do you think if it's paid via credit cards and cash (however that works?), that this surgery could still happen on Tuesday?
Bummed in Raleigh, NC
Stefanie