Guest guest Posted May 2, 2001 Report Share Posted May 2, 2001 Hi All, I have BCBS Federal insurance who does not pre-authorize prior to surgery.(Sometimes) In our plan book it states " Gastric bypass surgery or gastric stapling procedures for morbid obesity " are covered. I know of at least 18 patients w/ the same insurance that they have paid for the DS for. My surgery was initially billed under an unlisted code and the op notes were requested. They denied my surgery saying it was experimental and investigational. I finally got my Dr's office to send in a corrected rebill using 43633 and 43847 but the damage was already done and I found out yesterday that they denied it again. I now have 2 levels of appeal. To the Oregon BCBS Fed and then to Wash DC. Office of Personnel Mgmt. 2 Questions for y'all. 1. Is our surgery a " gastric bypass or gastric stapling procedure " ? 2.Do they have to pay for my DS if they paid for other MO patients? (historical precedent?) As you can well imagine I'm terrified at this stage. The thought of 30k in bills is just so overwhelming. Any thoughts or advice. Thanks. Lap LG/DS 1/23/01 Dr Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.