BCBS World

henry4956 · #1 (**permalink**) 04-24-2014, 02:36 PM

I have BCBS and just had 2 level lumbar ADR surgery in Bonn Germany with Dr Zeegers and I have friend who had exact same surgery with Dr Clavel in Spain 4 months ago. My friend recently informed me that BCBS world has compensated him for EVERYTHING except a $500 deductible and the hotel fee.

The key I believe is not submitting through the normal channels and finding the number for BCBS WORLD. Anyone who has BCBS and has recently had or is contemplating adr surgery should be excited!

odiekimmell · #2 (**permalink**) 04-30-2014, 06:19 PM

Hi henry4956,
Have you submitted your claim to BCBS yet? Does your policy have specific language that states international services are covered? Did BCBS know that you were going to Germany for the sugery?
The answer to these questions is extremely important by what the answer is.
If BCBS has no exclusions for surgery overseas and they didnt require authorization or to know ahead of time about the surgery then you might have a chance to recoup your money.
Are you familiar with submitting claims for reimbursement for services?

Would love to help.
Odie

vnf · #3 (**permalink**) 07-09-2014, 08:33 PM

Henry

I have BCBS too.
I wonder if I can get any of my surgery covered?
Let me know if you get anything worked out.

mmglobal · #4 (**permalink**) 07-10-2014, 07:48 PM

Vicki, welcome to the forum. You might want to send Henry a private email and ask him to update this thread.

Good luck!

Mark

vnf · #5 (**permalink**) 07-12-2014, 05:12 AM

Thanks Mark and we have chatted by phone

Henry makes for a good shoulder!

henry4956 · #6 (**permalink**) 08-11-2014, 05:06 AM

I really had my hopes up when a BCBS WW rep called me about a month ago. He needed for me to have one document that was not legible resubmitted. This made me think, they are working on it - so that's good.

2 weeks ago I contacted BCBS RI and referred to my case # and was told all that was missing was a pre-auth or letter of medical necessity. Even if it was after the fact it would be OK. I created a draft and Dr Zeegers filled in the rest. I submitted it and about a week or so later they tell me it has been denied. I was told it would only be paid for if the surgery was an emergency and not planned in advance.

My wife just so happens to work for the man at RI Hospital who is the head guy for all things BCBS related. Her co-workers have told her he has the authority to make a call (pull a few strings) and I would get reimbursement.

At this point it seems that is my only chance. So far we have been trying to do this thing by going thru all the proper channels and it has gotten us nowhere.

How are you doing Vicki?

vnf · #7 (**permalink**) 08-18-2014, 05:32 AM

Henry

I'm hangin in there

Going today for SI joint injections since I have alot of pain in the tailbone area.
Probably referred pain from the L5 level but going to give the shots a try.
Thanks for asking

My BCBS says that I have benefits and gave me a case # too.
Haven't submitted a pre auth letter and will probably get the same
bs you got! I hate insurance companies.