Hi friends. A year post my first surgery and Blue Shield of CA has finally paid my surgical claims from both surgeries! After a long battle they finally retroactively authorized the surgeries but then the fun and games really began. First they reprocessed the original claims and then once again denied them. Then they had me have Banner Health submit new claims and they denied those as well…even with the authorization in place. It was a game of procedure codes that I could never win because Blue Shield of CA wouldn’t speak directly to Banner it had to be the local Blue Shield office and they were apparently out of the loop. Anyway, with the help of the CA state board of insurance Blue Shield of CA finally gave up the game and I see on my insurance dashboard that all the claims have been paid. Now I just have to deal with Banner and the anesthesiology group to get reimbursed. Just wanted to share the good news, especially for anyone struggling with getting insurance approval.
That’s great news! I hope it doesn’t take too long for you to be reimbursed too, all sounds very stressful so glad that it’s nearly over! 
@Chrickychricky - I feel that BC of CA’s behavior is inexcusable. You pay for your medical insurance in good faith. You followed their out of network guidelines also in good faith so there is no reason you should have had to jump through the hoops they set up over & over again for a year. I think they owe you more than a reimbursement … like a major apology! I applaud you for maintaining the upper hand & finally receiving the “prize” at the end. What a ridiculous ordeal!!
Hi. I don’t know if you’re still around, but BS of CA declined to pre-authorize my surgery today, saying it wasn’t necessary. But I’m told, then they’ll just deny it later as not medically necessary, so my surgeon’s office (Dr. Costantino) understandably wants us to get Blue Shield to commit before I have the surgery. Did the CA Board of Insurance issue any sort of letter or opinion about your case, or is there anything you could share, or point me in the right direction? I’m a recovered lawyer so I can in theory do some research, but my brain fog and cognitive decline are quite legit. Ugh! So glad you got them to cover what you needed. I hope you’re feeling well now. – t.
Good morning,
I’m so sorry to hear you are going through this with them and you have to advocate for yourself when you are feeling your worst physically and mentally. I’m happy to help in any way I can. Before I launch into anything, I just want to make sure I understand it correctly. Are denying the surgery itself as not medically necessary or are they denying Dr. Costantino as the surgeon because he is not a Blue Sheild of CA provider?
I’m sorry that you’ve had the authorisation denied, I hope that you can get this sorted…Can you speak to an advocate with your insurance company, I think others have said that all companies should have one?