My orthopedists office will not book surgeries until they have the approval code in their hand.
for my last surgery of Jan7th. My head was on my chin with x-rays showing a 90 degree turn at the top of my thoracic spine and I had equipment sticking out of my back from my recent thoracic/lumbar fusion/osteotomy. Not to mention the pain getting worse every day. I just stayed in bed toward the end it was too painful just to walk and i know i looked weird as i could not put my head up.
Well the surgery was denied by Blue Cross of Ca. The doctors office was right on it and the peer to peer happened within days. I was told it was going to be approved probably the next day. Well i faced 2 more denials,of not neccessary.
I was lucky the assistant at my surgeons office was so confused with all my paperwork as i had 3 surgeries in a row that she set up the date of Jan 7th.
Once i got really involved i realized my spine docs office had never sent the xray. So i went to his office to get the Ctand MRI , i already had the xray as it was so unbelievable, got all the reports and told them i was driving the 2 hours to Blue Cross to deliver it as they never got the xrays there.
Well then the office person asked where i got the xray. I told her everything came from their office and if they could email it all i did not havea to make the drive. My poor doc had 2 other peer to peers also and it finally got approved, but 3 denials first.
All for an error. also Blue Cross told me there was a coding error as well. I can't believe they would not just fix it instead of keeping it a secret as to what is wrong.
To save my date i had told them i would self pay . My doctor assured me no surgeon could deny this after seeing the xray. They just wanted someone other than him to say what was going on. So i was not afraid to put my self out on a limb but really would have to get the money from my parents.
Good luck and let me know if you need a body to join you at Blue Cross office.
judy
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