I had my right side styloidectomy done back in September. I thought everything had gone through and was taken care of insurance/payment-wise so in March I got the left side surgery scheduled (for May 2). I just got a call from the surgery center and they said they are still fighting with insurance to get them to cover the first procedure so I will have to sign an advanced beneficiery notice if they can’t get it resolved before my next procedure. I’m feeling a bit blind-sided as this is the first I’ve heard of the whole situation and also now stressed about whether I should even move forward with the next procedure or if there’s anything I can do to resolve this sooner, especially since the procedure code being submitted to the surgery center is the same as last time so the results are likely to be the same. Does anyone have any advice or suggestions? It’s so frustrating. I just want to have this all done and have a throat that functions normally for swallowing and breathing and all the things it’s supposed to do when there’s not a bone pressing in on it that’s not even supposed to be there.
I’m really sorry this happened to you, @Becc87! Do you know what procedure was billed? Apparently insurance companies don’t recognize billing for Eagle Syndrome or styloidectomy but they will cover a “craniectomy” which is how both my ES surgeries were billed. It’s actually an accurate description of what a styloidectomy is. You could ask for the surgery center to rebill the procedure as a craniectomy if they didn’t do it that way the first time.
It looks like my ENT surgeon’s office sent over the “unspecified” code his billing person decided to use initially as well (21499). He had her rebill it under craniectomy (which he had initially used to when checking with insurance) and it got covered. I didn’t realize that the surgery center was using the same code until after they closed on Friday so I called and left a message with the correct code to use and will follow up with them on Monday.
I don’t want to put of my surgery any longer as I put it off for several years already and am nervous the muscles and nerves that have been impacted will not be able to work the way their supposed to once that bone is out of the way (Half of my throat doesn’t move when swallowing because the syloid and S-H litament are pushing into my throat behind my tonsil on that side). I’m just praying that they can rebill and get a response in less than two weeks.
I will pray for that request, too, @Becc87, that your insurance company will prioritize reviewing your claim w/ the new billing code so you can get your second surgery on the date you have planned.
If you can ask the surgery center or your doctors office to request the claim review to be done STAT that might help.
The saga continues. Apparently my doctor sent over the craniectomy code but the surgery center verified the code with a 3rd party coding company who told them that they should use the “unspecified/unlisted” code as it was more “precise”. It also requires pre-authorization which no one at the surgery center cared to look into in the month between my surgery being scheduled and my surgery happening. Now they are trying to get it retro actively authorized which is going as well as I’m sure you imagine it going.
So today after speaking with billing, I called and asked to speak with the office manager. I had a conversation with him about the coding situation, the lack of their office being upfront with me/waiting til the last minute, and insistence on this code over patient care (i felt like numbers on a page were more important than my quality of life). He was going to head down the the billing office and speak to them as soon as we got off the phone and will get back to me tomorrow. I’m half terrified I’m just going to have to put this surgery off indefinitely and half furious at the way this surgery center has handled things when the surgeon and the anesthesiologist had no issues and bills with them were paid by insurance and myself by the beginning of January.
@Becc87 - That is so totally frustrating! You did an AMAZING JOB of advocating for yourself!! I hope it pays off BIG TIME!! It seems they owe you after making so many mistakes especially since you have an impeccable track record w/ them after your first surgery minus the billing code snafu which is now rearing its ugly head but you had nothing to do with that.
“Unspecified/unlisted” as a billing code makes some sense, but I think craniectomy is more accurate because that’s what a styloidectomy is…a small piece of the cranium is being removed i.e. the styloid process is part of the mastoid process which is part of the temporal bone of the skull/cranium. It is “guilty by association” as it were. 
Sorry you’re going through this. Insurance can be very difficult. Make sure you tell them that they are denying you QUALITY HEALTH CARE. Have them do a peer to peer explaining that you have to have the other side surgery, since the first surgery has made the other side tightened and more symptomatic- making life quite unbearable. Explain all the symptoms and how now things are worse. Hoping you can stay on schedule
I got the official word today that its all cleared up! Insurance was denying their claim partially because they were using “the wrong code”. My insurance told the billing folks today they want the bills to use the craniectomy code (what I’ve been telling them for several days and my doctor told them in September…ugh). As such, they will rebill it and I don’t have to sign an ABN to have my next surgery!
Thank you for all the encouragement! I’m so grateful to have found this group as I walked through all this. Thoughts and prayers for next Thursday morning when I go in for surgery and the following days of recovery are welcome and appreciated!
That’s great news @Becc87 , so pleased that it’s sorted for you, and will pray that your surgery next week is successful 
