Things going too smoothly - time for more insurance screwups!
After returning from a wonderful week in Williamsburg, Jamestown, and Yorktown, Virginia with my family I checked our home phone messages. There was a message from my OS's office saying that they had gotten a letter from BC/BS of Mass. The MMA had been officially approved but the GA had been denied because it was cosmetic. Cosmetic? Are you kidding me? Having one's chin tip sliced off in order to pull the tongue forward is sexy, no?
This morning I called my OS office and spoke with the insurance clerk. She read the insurance denial letter to me (I have yet to receive anything official directly from BC/BS.) She told me that the Lefort I osteotomy and the BSSO are both approved but they were denying the genioplasty tongue advancement. I asked if the "genioplasty" term made it seem like a cosmetic rather than medically necessary procedure. She assured me that it was the appropriate term and told me that all of the physician's notes, cephalograph info, xrays, etc. had been filed. She told me it was now in my court to take this up with BC/BS. She gave me the name of the UR nurse that had been handling my case. Before calling her I decided to call the head of HR for my husband's company. She was familiar with me and helped trememdously with the insurance problems I had before. She was helping me think through all of what I would need to ask/tell the insurance folks. Before I could call BC/BS I got a call back from the OS office. The new, on-the-ball clerk checked what had been filed to make sure it looked alright. She double-checked the codes that were filed. Turns out that the old insurance clerk (the one that was involved with the previous problems and has since been freed up to find new employment) filed the right procedure terms but with the wrong codes! The code that she used was for a genioplasty (the cosmetic kind) and not the genioglossus advancement! Dr. Hudson has dictated an amended letter and the new clerk has been on the phone with the UR nurse with BC/BS. The UR nurse will be expediting this to see if they will now cover the procedure. So - push comes to shove I will be writing out at check for $3K next Wednesday that hopefully I will get reimbursed after the surgery. If all goes well (I am not holding my breath) the GA will be approved and this will be nothing more that another angry, stressed-out day dealing with insurance problems. Unfortunately I won't know if the re-filing works until late this week.
Just an aside - I keep mistyping insurance as unsurance. I think I like the typo better.
Through all of this mayhem Toni (Learian) and Bill (SeattleBill) from the sleepnet forum have been wonderful, supportive friends.
On another note, daughter told me that she had a stomach ache all day today. She is doing some preemptive worrying. I have some more comforting and reassuring to do.
Peace,
Anne
This morning I called my OS office and spoke with the insurance clerk. She read the insurance denial letter to me (I have yet to receive anything official directly from BC/BS.) She told me that the Lefort I osteotomy and the BSSO are both approved but they were denying the genioplasty tongue advancement. I asked if the "genioplasty" term made it seem like a cosmetic rather than medically necessary procedure. She assured me that it was the appropriate term and told me that all of the physician's notes, cephalograph info, xrays, etc. had been filed. She told me it was now in my court to take this up with BC/BS. She gave me the name of the UR nurse that had been handling my case. Before calling her I decided to call the head of HR for my husband's company. She was familiar with me and helped trememdously with the insurance problems I had before. She was helping me think through all of what I would need to ask/tell the insurance folks. Before I could call BC/BS I got a call back from the OS office. The new, on-the-ball clerk checked what had been filed to make sure it looked alright. She double-checked the codes that were filed. Turns out that the old insurance clerk (the one that was involved with the previous problems and has since been freed up to find new employment) filed the right procedure terms but with the wrong codes! The code that she used was for a genioplasty (the cosmetic kind) and not the genioglossus advancement! Dr. Hudson has dictated an amended letter and the new clerk has been on the phone with the UR nurse with BC/BS. The UR nurse will be expediting this to see if they will now cover the procedure. So - push comes to shove I will be writing out at check for $3K next Wednesday that hopefully I will get reimbursed after the surgery. If all goes well (I am not holding my breath) the GA will be approved and this will be nothing more that another angry, stressed-out day dealing with insurance problems. Unfortunately I won't know if the re-filing works until late this week.
Just an aside - I keep mistyping insurance as unsurance. I think I like the typo better.
Through all of this mayhem Toni (Learian) and Bill (SeattleBill) from the sleepnet forum have been wonderful, supportive friends.
On another note, daughter told me that she had a stomach ache all day today. She is doing some preemptive worrying. I have some more comforting and reassuring to do.
Peace,
Anne
posted by Anne | 10:36 PM
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