++Anthem insurance Colorado, surgeons dont accept, any advice?++

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Fourtay
Posts: 2
Joined: Thu Jun 07, 2018 8:01 pm

++Anthem insurance Colorado, surgeons dont accept, any advice?++

#1 Post by Fourtay »

Hello,
I have anthem blue cross blue shield. No orthognactic surgeons accept it that i've found in colorado. They'll do a refferal but anthem apparently doesn't pay much for the surgery. (upper maxilla advancement and lower mandible advancement) I've been ballpark'd at 20k for doctor 20k for hospital. Surgeons say I'll have to pay in full before surgery and then the insurance will reimburse me later but significantly less than cost.

Anyone have any suggestions?

Thank you for your time.

snapdresser
Posts: 913
Joined: Wed Feb 18, 2015 7:31 am

Re: ++Anthem insurance Colorado, surgeons dont accept, any advice?++

#2 Post by snapdresser »

You need to go on the BCBS website and find an in-network surgeon. That's what I had to do. The first surgeon I went to wasn't in-network for any insurance policies at all, so I went on the BCBS website and found a less well-known one. When I saw the bills, I was glad that I had. The original cost would have been $95k for the whole shebang, but the plan allowance was about $35k, and my insurance paid all but about $2k of it, that I ultimately had to foot the bill for.

Do you have medical necessity for this surgery? If you do, your surgeon will have to file for pre-approval with BCBS, of course. If you don't have medical necessity, then it's unlikely that any insurance will cover it regardless of whether or not the surgeon is in-network.
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runrabbitrun
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Joined: Tue Mar 06, 2018 8:51 pm

Re: ++Anthem insurance Colorado, surgeons dont accept, any advice?++

#3 Post by runrabbitrun »

Do you have documentation that proves that the surgery is medically necessary? If not (as snapdresser said), then it won't be covered regardless of whether or not you find a surgeon who accepts your insurance. Ask Anthem for the list of requirements that must be met in order to deem the surgery medically necessary. If you meet the requirements but can't find a surgeon in your area that's in-network, you might be able to use an out-of-network surgeon, but IDK if all ins. companies allow this. My ins. company's policy is that if there isn't an in-network physician/surgeon within 50 miles for the treatment that you need, they'll cover one that's in-network in the same 50-mile range.

Fourtay
Posts: 2
Joined: Thu Jun 07, 2018 8:01 pm

Re: ++Anthem insurance Colorado, surgeons dont accept, any advice?++

#4 Post by Fourtay »

[quote=snapdresser post_id=502604 time=1528469000 user_id=24383]
You need to go on the BCBS website and find an in-network surgeon. That's what I had to do. The first surgeon I went to wasn't in-network for any insurance policies at all, so I went on the BCBS website and found a less well-known one. When I saw the bills, I was glad that I had. The original cost would have been $95k for the whole shebang, but the plan allowance was about $35k, and my insurance paid all but about $2k of it, that I ultimately had to foot the bill for.

Do you have medical necessity for this surgery? If you do, your surgeon will have to file for pre-approval with BCBS, of course. If you don't have medical necessity, then it's unlikely that any insurance will cover it regardless of whether or not the surgeon is in-network.
[/quote]


I have gone to their site to find in-network surgeons, however I haven't had any luck finding a surgeon who is in network, or if they are in network, they dont perform the surgery.

I guess I will keep looking to see if there are any in network. Do you know what surgeon you used? Anthem tells me I might be able to cross state lines to get the surgery done if they accept bcbs. Bcbs

snapdresser
Posts: 913
Joined: Wed Feb 18, 2015 7:31 am

Re: ++Anthem insurance Colorado, surgeons dont accept, any advice?++

#5 Post by snapdresser »

Fourtay wrote:
Thu Jun 14, 2018 4:32 pm
I guess I will keep looking to see if there are any in network. Do you know what surgeon you used? Anthem tells me I might be able to cross state lines to get the surgery done if they accept bcbs. Bcbs
Dr. Tracey Rosenberg in Long Island, NY. She did a great job. That's a haul for you, though. How many in-network Maxillofacial Surgeons in Colorado did you contact that told you that they don't perform this surgery?

I took the liberty of looking up some OMF surgeons in Colorado. I searched for Denver simply because I don't know what city you're in, and there were 5 in-network OMFs. Their details are attached. If you haven't contacted them to make sure they're in-network for your particular plan and to find out if they do orthognathic surgery, you might consider it.
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