Thank you for sharing your story @Susie! That’s evidence that there are some insurance companies which don’t exist make our lives frustrating.
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Hi! I’m sorry that you had such a surprise regarding the insurance. I was told about a week before my surgery that the insurance wasn’t going to cover it. It was a huge surprise because I had already been told that the preauthorization was taken care of. & I was initially a little stressed out by that. Anyway, my doc’s office got in touch with the insurance co. and filled out the form stating that this is a very specialized procedure that needed to be done & it was approved. I also have Anthem BC/BS. My surgery was also done out of state as there were no providers in my state that have expertise in the styloid/C1 surgery either. I think that as long as the doctor documents the condition you have and the required expertise for the surgery, there shouldn’t be too much of a problem to get it covered. The insurance coordinator at my doc’s office was extremely helpful & knowledgeable about what needed to be done to get the insurance coverage in place for the surgery. I hope that you get the approval you need so that your surgery is covered. I’m glad you went ahead with the surgery anyway & now you can be healing. Hope that your pain has lessened as well and that you’re feeling better today!
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Frustrating??? Ohh, what a very polite way to put it @Isaiah_40_31 
Personally, I have some MUCH stronger words. None I shall mention here.
@Susie You had a bit of luck in obtaining the dental cover. I’ve had the ‘joy’ (NOT) of dealing with these companies, both in a professional manner (making claims for clients) and personally (making a claim for myself). From my experiences, If they have ANY cause to null and void cover, they will. I fought tooth and nail making a claim for a client after someone pulled up to his house with a truck and took EVERYTHING (even the food in his cupboards). He had paid for the cover, had a right to that cover and I made sure he got it.
So when my claim went in I thought “I’ve done this before, I can do this myself”. Well, the insurer messed me around for months. In the end I had to get the lawyers involved. The insurer didn’t like that and it did cost me $$$$, but the lawyer saved what little sanity I had left because the insurer were just nasty.
Merl from the Modsupport Team
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Merl,
You made me 
. I’m sorry for what you went through especially as an insurance employee (even if it was a prior occupation). Hopefully @Chrickychricky won’t have to go to the extreme you did to get the coverage she deserves.
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Thanks all for sharing your stories. I sent an email to Dr. Nakaji’s biller asking her to contact Dr. Costantinos biller to see what magic he has figured out. A bill from the nerve monitoring company came in yesterday for $45,000. I know it’s all yet to be negotiated and the insurance still has to be appealed but it is very stressful to see such ridiculous numbers. I tried to get started with Blue Shield of CA yesterday but the phones were down due to the big tech glitch that occurred yesterday. I couldn’t get through to Banner Health either to see how far they have gotten on their end with the insurance. So I will just have to pick up again on Monday.
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That’s crazy money, praying it gets sorted 
Though the process may take time, I’m praying the appeals will prevail & your out of pocket will be as minimal as possible, @Chrickychricky. $45K sounds like what insurance would be billed not a cash paying patient. That’s a ridiculous amount!!
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Hello! I hope that everything is going well. I just wanted to let you know that I found out what the person at Dr. Costantino’s office used to get my surgery approved. It is called a gap exception. I know that Dr. C’s office had to fill out some paperwork & was in verbal contact with the insurance company prior to my surgery being approved. I hope that you’ve been able to make some progress on your insurance situation. Also, I hope that you are feeling well & continuing to improve.
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Hi there,
My recovery is going well and I’m scheduled to have the other side done in October. I really appreciate your sending this info. So kind! I totally forgot that the biller told me she was applying for gap coverage. It was the last minute the afternoon before the surgery. I just emailed her to see where she got with that. In the meantime, I filed an appeal with my insurance company. They denied covering the surgery because they said I have neurosurgeons in my plan. Of course, none of them have any experience with VES surgery. I wrote a letter explaining the rarity of this disorder and the need for very specific expertise. I sent a few journal articles to support my assertions. The doctor said he would also write a letter supporting the need for a surgeon with specific experience. Based on your earlier email I gave the name and numbers of 2 people at Dr. Costantino’s office in case they wanted to gather their own info biller to biller. I hope something good happens! Thanks again for thinking of me and following up.
Christine
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