Surgery!?!?!?!

[Lucifina]

Ok, this is horrific! I went in to the surgeon and all went well. He said everything was ready for the surgery when the ortho said go…all he had to do was submit the insurance again…b/c he told me when I decided to do this that BCBS would deny me the first time but then he would resubmit it and then it would be accepted. This is what he told Mister and I two friggin’ years ago when I decided to do this in the first place. I was totally against surgery to begin with and would have never have agreed to it if he had not told me that he would get it covered but he was so adamant that it would be covered…so I agreed and proceed on getting my mouth rearranged to go along w/the surgery plan as opposed to option B , the non surgery plan. Well now I call the office to see if it was approved and the office lady said it was denied and I said ok, well he told me that would happen and she said well all of out resubmits are being denied this year!!! I am like WTF!?!!?!? Resubmit!!! She said ok but that it will be denied, I was like WTF am I supposed to do?!?!? I told her that I only had my whole mouth rearranged for two years so I could have this surgery because the doctor told me that it would be covered! She was like well there is nothing we can do, but it is $12,000.00 to have it done. So now I am considering just offing myself b/c there is no way I can just magically come up with $12,000.00 out of no where to pay for this and it is not like they can put my teeth back after moving them around for two years. I mean I would not really off myself over teeth but really, this is just maddening! The thing that makes me so made is I was so against the surgery in the first place! Grrrrrr! Anyway I have an appt w/my ortho on 11/04 I think and I have no idea what to tell him. This whole thing is just absurd.

[Delag]

I know this seems really overwhelming at the moment, but if you think about it - of course she is going to tell you that all resubmits will be denied. If you dont resubmit then that saves her a lot of work. This is how they operate - they try to make you give in and quit trying. It is horrible, but it is how they win. Don't give in - make it eaiser for them to approve you by being a royal pain in the arse. You have every right to be angry - just use that anger to your advantage without pissing them off. (((hugs)))

[pokergirl]

Lucifina, Delag is right. They want you to just give up and either pay for it yourself or not have the surgery at all. I went around and around with my insurance company denying mine after they had approved it two years earlier. They basically said that they weren't obligated to pay for it after two years and denied me twice. I finally got my insurance agent involved who is a personal friend and he got it taken care of. I'm now getting a few bills in the mail on stuff that the insurance didn't cover. I'm so wanting to mark DENIED on them and send them back. Hee Hee! Anyway, just keep calling them.

[HighandLo]

Lucifina,

What a pain! You may want to take a look at your insurance coverage and then write a letter (or fax) to your insurance carrier. I did this to explain my reasons for surgery after my claim was denied once. It clearly stated what they will pay for and I was covered, as long as the OS's office sent in the appopriate backup info (which they didn't do the first time).

I found my 2007 coverage (through Cigna) on the Internet and circled the pertinent parts and sent those pages, too. Just so they know to take your case seriously.

Lo

[Lucifina]

Thanks guys! I fell calmer now…still mad but calmer.
I have my appt w/my ortho on 11/07 and I will let him know what is going on and I will call my OS on Monday again and see if they have heard back on the resubmit yet. I have decided that once the whole back and forth is done and if it ends up that I do have to pay out of pocket I am going to find a different OS. That man will not get my moola! If he can get the ins to go through great but if not, his loss, I will find another surgeon and pay them the cash.