Hospital Bill

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shelbyhome
shelbyhome Member Posts: 145
edited March 2014 in Breast Cancer #1
I just recieved my bill from my exchange surgery and Blue Cross is saying that it is cosmetic and they aren't paying for the 10,300.00 bill!!!!!! I think I will be on the phone with them first thing in the AM. Wish me luck.

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  • sea60
    sea60 Member Posts: 2,613
    #2
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    Yikes!!
    NOTHING asociated with Breast Cancer should be deemed "cosmetic!" Ugh!

    I'm praying that they change that. Keep us posted!

    Sylvia
  • carriesoup
    carriesoup Member Posts: 144
    #3
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    ugh. good luck! insurance
    ugh. good luck! insurance companies suck! just love getting a bill for 10,000! would you like that in cash?!? i've had to deal with blue cross before, and i can say that they cleared things up.
    hope they don't give you a hard time.

    carrie :)
  • HeartofSoul
    HeartofSoul Member Posts: 729 Member
    #4
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    just curious, was the
    just curious, was the surgery pre authorized before hand
  • New Flower
    New Flower Member Posts: 4,294
    #5
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    HeartofSoul said:

    just curious, was the
    just curious, was the surgery pre authorized before hand

    from my experience
    in addition to phone call please follow up with letter.
    Good luck
  • tommaseena
    tommaseena Member Posts: 1,769
    #6
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    New Flower said:

    from my experience
    in addition to phone call please follow up with letter.
    Good luck

    questions to ask
    when you call the insurance company keep in mind that they may have said this because the hospital may have put the incorrect diagnosis code on the bill so ask what diagnosis code the hospital submitted on the bill. If it is a hospital error then you will need to call the hospital billing department and have them correct this and resubmit this to your insurance company again with the correct codes on it. If the insurance company paid for the mastectomy and the tissue expanders then they should pay for the exchange since expanders are not meant to stay in a person forever.

    As your insurance company if there is a clause on your policy that states that they have to pay to bring your body as close to pre-cancer state. If you have this clause then once the bill is corrected and resubmitted then they will pay.

    Have you received your EOMB(Explanation of Medical Benefits) statement from the insurance company? If you have check out the reason they have put there and it might help when you call them. They may not have paid because someone at the insurance company placed the wrong provider code in the claim and that doctor doesn't participate with your insurance company--this happened to me--and once they brought up the claim they could see that they had made an error and then reprocessed the claim.

    Hope this helps.
    Let us know what happens.

    Margo
  • VickiSam
    VickiSam Member Posts: 9,079 Member
    #7
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    tommaseena said:

    questions to ask
    when you call the insurance company keep in mind that they may have said this because the hospital may have put the incorrect diagnosis code on the bill so ask what diagnosis code the hospital submitted on the bill. If it is a hospital error then you will need to call the hospital billing department and have them correct this and resubmit this to your insurance company again with the correct codes on it. If the insurance company paid for the mastectomy and the tissue expanders then they should pay for the exchange since expanders are not meant to stay in a person forever.

    As your insurance company if there is a clause on your policy that states that they have to pay to bring your body as close to pre-cancer state. If you have this clause then once the bill is corrected and resubmitted then they will pay.

    Have you received your EOMB(Explanation of Medical Benefits) statement from the insurance company? If you have check out the reason they have put there and it might help when you call them. They may not have paid because someone at the insurance company placed the wrong provider code in the claim and that doctor doesn't participate with your insurance company--this happened to me--and once they brought up the claim they could see that they had made an error and then reprocessed the claim.

    Hope this helps.
    Let us know what happens.

    Margo

    This sounds very werid .. Pre-Authorization confirmed or given
    ??? Please check ... my exchange ran me and blue cross over $33,000.00 - same day surgery - the cut and release program.

    No wonder many Californian doctors hate this new 'reform' health care, they will be forced to reform their charges for surgery and services .. I hope 'reform' helps us everyday 'joe's and joanne's' ..

    Let us know .. what happens .. next ..


    Vicki Sam
  • VickiSam
    VickiSam Member Posts: 9,079 Member
    #8
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    VickiSam said:

    This sounds very werid .. Pre-Authorization confirmed or given
    ??? Please check ... my exchange ran me and blue cross over $33,000.00 - same day surgery - the cut and release program.

    No wonder many Californian doctors hate this new 'reform' health care, they will be forced to reform their charges for surgery and services .. I hope 'reform' helps us everyday 'joe's and joanne's' ..

    Let us know .. what happens .. next ..


    Vicki Sam

    Please note ... a little fuzzy from surgery yesterday .. Margo
    brings up .. valid and valuable insight ....


    forgot to add this ... to my rant.


    Vicki Sam
  • shy violet
    shy violet Member Posts: 167
    #9
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    VickiSam said:

    This sounds very werid .. Pre-Authorization confirmed or given
    ??? Please check ... my exchange ran me and blue cross over $33,000.00 - same day surgery - the cut and release program.

    No wonder many Californian doctors hate this new 'reform' health care, they will be forced to reform their charges for surgery and services .. I hope 'reform' helps us everyday 'joe's and joanne's' ..

    Let us know .. what happens .. next ..


    Vicki Sam

    Scared to see what my bill
    Scared to see what my bill will be for four days in hospital for cellulitis...first experience with medicare...they came three times to ask how I was paying te 1100 dollar deductible just for being admitted...but the supposed good news was had I been in the hospital within the last 60 days I would only have to pay one 1100 deductible...wait, let me do a tap dance for that...no I wasn't...
  • tjohnson2310
    tjohnson2310 Member Posts: 168 Member
    #10
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    Its the Law
    I just read an article today in Essence magazine that according to the Women's Health and Cancer Rights Act of 1998 health insurance companies are required to cover breast reconstruction surgery. This is not cosmetic surgery.
  • shelbyhome
    shelbyhome Member Posts: 145
    #11
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    Ok well after I called the
    Ok well after I called the Dr. and found out that he was paid and they paid the for anesthesia, I called Blue Cross and they said that it is covered that the hospital must have coded it wrong!!! All I can say is I was sure that it was covered but it made me uneasy to see the bill which was really the explanation of benefits from Blue Cross.
  • carkris
    carkris Member Posts: 4,553 Member
    #12
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    shelbyhome said:

    Ok well after I called the
    Ok well after I called the Dr. and found out that he was paid and they paid the for anesthesia, I called Blue Cross and they said that it is covered that the hospital must have coded it wrong!!! All I can say is I was sure that it was covered but it made me uneasy to see the bill which was really the explanation of benefits from Blue Cross.

    I dont blame you I would be
    I dont blame you I would be alarmed at a bill for 10K. GLAD IT WORKED OUT.
  • jnl
    jnl Member Posts: 3,869 Member
    #13
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    shelbyhome said:

    Ok well after I called the
    Ok well after I called the Dr. and found out that he was paid and they paid the for anesthesia, I called Blue Cross and they said that it is covered that the hospital must have coded it wrong!!! All I can say is I was sure that it was covered but it made me uneasy to see the bill which was really the explanation of benefits from Blue Cross.

    So happy that you found out
    So happy that you found out that your bill was paid.


    Hugs, Leeza
  • Brooklynchele
    Brooklynchele Member Posts: 123
    #14
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    BCBS
    BCBS denied my claim for my wig. Granted, the cost doesn't compare to yours but still - both are covered services under our policies!

    Good luck!

    Michele
  • chenheart
    chenheart Member Posts: 5,159
    #15
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    Well, it's Monday! I know
    Well, it's Monday! I know you are so relieved to be staring the week knowing your procedure was covered, afterall!You put the GRRRRRRR in Girl-Power! Hooray!!!!!

    Hugs,
    Chen♥

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