One of the representative at BCBS said that if i had the surgery treatment codes from my surgeon than they cold give me the guidelines as to how to go about getting the surgery covered (eg watiitng period, cause for surgery). When i calle dback with the codes, I happened to get another representative on the line and they said that they could not give me the benefit details because i was not their member yet.
Do the insurance companies give or do not give the plan details to the new customers? I think they are supposed to becasue how am i blindfoldly gonna choose a plan without knowing the benefits?
Please let me know . I have no idea what to do
Thanks
Surgical treatment codes for the insurance
Moderator: bbsadmin
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bracesscared
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Reimbursement for elective procedures like orthognathic surgery is far from a science. What I can promise you is you aren't going to be able to call up the customer service number and get an answer. If they tell you "yes" or "no", I'd put next to no credibility into their statement.
The best thing to do is to have your surgeon's experts submit your records to request approval for the surgery. They should have treatment coordinators to do this for you. You shouldn't have to be doing all of the paperwork and running around with the insurance company (unless you are trying to appeal).
If you are shopping for insurance speak with your surgeon's office to get their perspective on who pays the best reimbursement rates in their experience. Or better yet, look for a plan where your surgeon is part of a network. Unfortunately, it is getting increasingly rare for oral surgeons to be a part of any Insurance plan, simply because the reimbursement rates are shockingly low.
The best thing to do is to have your surgeon's experts submit your records to request approval for the surgery. They should have treatment coordinators to do this for you. You shouldn't have to be doing all of the paperwork and running around with the insurance company (unless you are trying to appeal).
If you are shopping for insurance speak with your surgeon's office to get their perspective on who pays the best reimbursement rates in their experience. Or better yet, look for a plan where your surgeon is part of a network. Unfortunately, it is getting increasingly rare for oral surgeons to be a part of any Insurance plan, simply because the reimbursement rates are shockingly low.
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queenofoverbite
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Just so you know...
BCBS has a blanket policy that anyone needing orthognathic surgery is suffering from a birth defect. Unless you have a letter dated less than 31 days after birth detailing your "birth defect", they will not cover ANY of your surgery, let alone pre-approve you.
Even if your surgeon asserts that you need the surgery for a growth discrepancy, not a birth defect, they will not budge.
Trust me, I spent a year of my life battling their crap!
BCBS has a blanket policy that anyone needing orthognathic surgery is suffering from a birth defect. Unless you have a letter dated less than 31 days after birth detailing your "birth defect", they will not cover ANY of your surgery, let alone pre-approve you.
Even if your surgeon asserts that you need the surgery for a growth discrepancy, not a birth defect, they will not budge.
Trust me, I spent a year of my life battling their crap!
BSSO in Fall 2010!
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queenofoverbite
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BracketRacket
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- Location: East Coast, USA
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I just had SARPE (Lefort I), which they approved (eventually!)queenofoverbite wrote:Just so you know...
BCBS has a blanket policy that anyone needing orthognathic surgery is suffering from a birth defect. Unless you have a letter dated less than 31 days after birth detailing your "birth defect", they will not cover ANY of your surgery, let alone pre-approve you.
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BracketRacket
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bracesscared
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Did u mean that BCBS covered your surgery. If so, were u always insured with them or did u get the insurance and then had the surgeon file paperwork. Please let me know the process.BracketRacket wrote:Just to clarify, that doesn't mean that any other case would be approved, etc., it all depends on individual cases/plans/decisions. Just that not necessarily "never."
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mamaneedsanewjaw
- Posts: 139
- Joined: Fri Mar 12, 2010 9:06 am
BCBS has many different divisions hence many different policy restrictions. Many do have exclusions but some plans do cover in the case of medical neccesity. Just depends on the individual plan.queenofoverbite wrote:Just so you know...
BCBS has a blanket policy that anyone needing orthognathic surgery is suffering from a birth defect. Unless you have a letter dated less than 31 days after birth detailing your "birth defect", they will not cover ANY of your surgery, let alone pre-approve you.
Even if your surgeon asserts that you need the surgery for a growth discrepancy, not a birth defect, they will not budge.
Trust me, I spent a year of my life battling their crap!
I have BCBS Lumenous plan and have been preapproved for both upper and lower and shockingly and luckily enough on my first try.
That being said. No one on this board is going to be able to give you a definite answer about what your particular plan covers. All plans will have a waiting period, you need to be sure your specific plan doesn't exclude orthagnathic surgery. I know it is frustrating but only your insurance company will be able to give you the answer you are looking for.
