Guest guest Posted April 30, 2001 Report Share Posted April 30, 2001 Hi ; 1. I called the Seattle number and just gave them the NAME of the procedure, NOT any CPT codes. They questioned me as to if it is WLS? I said " yes " . They questioned about the medical necessity. I told them about my elevated BMI (over 56); that I'm 185 pounds over weight; and that I have several co-morbidities. They said that they use the same criteria as Medicare and as long as a person meets it, they're OK for whichever one; they don't mandate that it must be a particular procedure. 2. They also told me that the doctor's office would bill the Blue Cross office that is LOCAL to the doctor's office, not the Blue Cross local to the patient/member. I explained what doctor I was planning to use and which hospital and they said the bills would be sent to the Portland office so I needn't worry about 'in-network or out-of-network'. 3. When I read about the CPT coding problems that Dr. was having, I immediately suspected that Fed. Blue Cross would have a problem with it. The reason I say this is that Fed. Blue Cross follows Medicare guidelines EXACTLY. If something is even slightly off, they will probably deny it. But, if everything meets Medicare's guidelines, it can be an awesome insurance. You can go wherever you want to go for service and you don't need to get permission. That's why I keep choosing Blue Cross (High Option) year in and year out. I hope I've answered your questions. If not, please let me know. hugs, gobo DS pre-op BMI 56 " Sometimes We Never Know How We Influence the Lives of Others, Yet We Touch Those Lives Just the Same " > Hi Gobo, > > I have BCBS Fed as my primary insurance and they denied my Lap DS (W/ > Dr ) as experimental and investigational. Do you remember > who you spoke to that said that the DS was a covered surgery? Did you > give them the CPT codes 43847 and 43633 or did you give the name of > our surgery? Did you call the WA or OR office? Dr 's office > sent the corrected rebill 2 weeks ago so I am (NOT) patiently > waiting! Thanks in advance for the info. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2001 Report Share Posted April 30, 2001 Hi ; 1. I called the Seattle number and just gave them the NAME of the procedure, NOT any CPT codes. They questioned me as to if it is WLS? I said " yes " . They questioned about the medical necessity. I told them about my elevated BMI (over 56); that I'm 185 pounds over weight; and that I have several co-morbidities. They said that they use the same criteria as Medicare and as long as a person meets it, they're OK for whichever one; they don't mandate that it must be a particular procedure. 2. They also told me that the doctor's office would bill the Blue Cross office that is LOCAL to the doctor's office, not the Blue Cross local to the patient/member. I explained what doctor I was planning to use and which hospital and they said the bills would be sent to the Portland office so I needn't worry about 'in-network or out-of-network'. 3. When I read about the CPT coding problems that Dr. was having, I immediately suspected that Fed. Blue Cross would have a problem with it. The reason I say this is that Fed. Blue Cross follows Medicare guidelines EXACTLY. If something is even slightly off, they will probably deny it. But, if everything meets Medicare's guidelines, it can be an awesome insurance. You can go wherever you want to go for service and you don't need to get permission. That's why I keep choosing Blue Cross (High Option) year in and year out. I hope I've answered your questions. If not, please let me know. hugs, gobo DS pre-op BMI 56 " Sometimes We Never Know How We Influence the Lives of Others, Yet We Touch Those Lives Just the Same " > Hi Gobo, > > I have BCBS Fed as my primary insurance and they denied my Lap DS (W/ > Dr ) as experimental and investigational. Do you remember > who you spoke to that said that the DS was a covered surgery? Did you > give them the CPT codes 43847 and 43633 or did you give the name of > our surgery? Did you call the WA or OR office? Dr 's office > sent the corrected rebill 2 weeks ago so I am (NOT) patiently > waiting! Thanks in advance for the info. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2001 Report Share Posted April 30, 2001 > > Just so you know, I have BCBS FEderal and was approved for the DS LAp within 24 hours. I had my surgery with Dr Elariny in February which was less than one month after switching ot BCBS. I can't imagine why you would be denied. I would take it to appeal with the feds in washington. They have paid all my pre op and post op testing as well. No problems whatsoever. Jeannie Quote Link to comment Share on other sites More sharing options...
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