Geeze- it’s been jumping though one hoop after next, doing everything my insurance wants me to. I am in my final external appeal trying to get my surgery when low and behold Jules from Dr. Costantino’s office calls me to tell me that insurance overturned their decision! I was in a little shock and don’t think it sunk in. I was telling him that I just spoke with my advocate a few hours prior- and then the other line beeps in it was my insurance. I told Jules I’d call him back. My advocate confirmed that surgery has been approved! I am so lucky and thankful for the people who had helped this happen. First and foremost Jules at Dr. C office has been by my side holding my hand through all of this. Coaching me and fighting for me. My advocate through insurance has been very understanding and she has said from the beginning that if it was up to her it would be approved. She has been relentless, keeping very accurate notes of everything I’ve done all the doctors I’ve seen, and of all the symptoms I have and problems that I endure every day. I believe that everything happens for a reason, hopefully me fighting with the insurance company will help somebody else down the line who has the same situation. I’m hoping that the insurance company keeps good notes. So my date with Dr Costantino and Dr Tobias is March 8th. Thank you to my eagles family for the support, and the guidance you have given me. Fingers crossed it’ll be clear sailing from here on out.
YIPPEE! YAHOO!! HURRAY!!! FINALLY!!!
for self-advocation & doing what it took to get you to the doctor you wanted to see @lilwider! It’s also great that you won’t have to pay out of pocket now & can use the $ for something more fun. March 8 will come before you know it!
So surprised that insurance voluntarily overturned the decision without the final external appeal. Grateful and blessed!
Oh that’s fantastic news, I’m so pleased for you, well done for not giving up! 
Roll on March 8th …
Can I ask how you were able to get in touch with the BC/BS patient advocate?
I am scheduled for surgery on 8/25 with Dr. Costantino and Dr. Tobias and BC/BS only approved of 3 of the 4 codes that Jules submitted. I spent 3 hours trying to get through to a supervisor and Jules spent almost 2. This is very frustrating and I fear I won’t be able to go ahead on the 25th.
So sorry, as you know I fought hard to get approved.
I did everything the insurance company wanted me to do… go to the Drs they wanted me to go to and they were all inexperienced and not familiar enough. I told them that I deserve quality health care and a team who understands and has done more than a handful. I want the best. It was a big angle for me that I was “ being denied quality health care” make sure you stress that. I also informed them of the ignorance of Drs that had been dismissing me not understanding eagle with Venus outflow obstruction. I told insurance that if it’s not done I could turn my head the wrong way and possibly sever my carotid artery it stroke out. That there are many complications with the surgery that nerve monitoring needs to be done and if a problem arises on the table not just any Dr would be able to figure out what needs to be done next. I had just started getting a private advocate not with the insurance company and told my advocate about having someone else fighting for me. But it was just days after when I got the call that I was approved. Good luck to you I hope maybe i can help you a bit. You are in good hands.
@Johnny99 - We have another member who’s having surgery this week whose surgery was denied because of one procedure code as in your case. She doesn’t have BC/BS but her situation was the same as yours. The surgical scheduler in her surgeon’s office called the gal’s medical insurance to clarify what code they would cover that would accomplish the same aspect of surgery & was able to get her surgery approved that way. She isn’t seeing Dr. Costantino though.
I was reading on the forum that craniectomy (sp?) was the code many doctors use. I mentioned it to Costantino’s office and they said they would only use the 3. 
Do you know what the 3 codes are they use? When I had my ES surgeries (2014/15) there was no code for styloidectomy so the code for craniectomy was used back then. I understand there is now a styloidectomy code but there is also a code that’s used when it’s expected that C1 needs to be shaved. That seems to be the one that insurance companies don’t like to approve. You might try to check on that or have Dr. C’s surgery coordinator do it for you or at least work on it with you.
Different doctors use different procedure codes so I’m not very familiar with what the various insurance companies approve or disapprove of. Yours sound very straightforward @Johnny99. Do you know which one they’re declining?
@Johnny99, I don’t know if this discussion is at all helpful, @vcp02 has posted a link to a letter she & her husband wrote to their insurance company:
I hope that you’re able to get this sorted & then have the surgery later this month!
The only one they approved is the cranial nerve. They said the others don’t require pre approval and discarded them- very fishy. My doctor will not (nor do I want to) without approvals- especially since the other 3 are the most critical. To top it off- the hospital is not in network and thus the doctors aren’t since the surgery is in Connecticut.
@Johnny99 - Doesn’t Dr. Costantino also operate in a hospital in NY? If so, is that hospital covered by your BC/BS insurance?
@Johnny99 You can try asking for a peer-to-peer review where a doctor at your insurnace speaks directly with Dr. Costantino to sort out the details
He doesn’t do the decompression surgery in NY.
Over 5 hours spent on the phone to try and get through to a Supervisor and counting- their strategy is clearly to stonewall until I give up trying to get through to someone that can reverse the decision. I think I’ll have to contact the Attorney General’s Office soon
What state are you in?
New Jersey
I’m in CA and I ended up filing a grievance with the state department of managed health care. I wouldn’t have one without their weight.