Possible Blue Cross Blue Shield of Florida payment?

[staci70]

I apologize for the partial cross-posting from the Outcome forum. Here is our current insurance status:

We are currently appealing with Blue Cross Blue Shield of Florida. I've been watching the website, and noticed a change on 12/1.

Bills:

Surgeon (Discounted): $4,573.90
Hospital: $47,851.47 (see below. Note that this includes the $21k+ for the implant)

So, the incredible news is that BCBSFL seems to have paid the hospital bill. I've been checking their online account management every day, and it has been showing "Denied" for the Surgeon's bill (which is under appeal), but "In process" for the hospital bill. As of tonight, it shows:

Amount Billed: $47,851.47
Amount Allowed: $38,841.18
Amount Paid: $38,370.99
You Owe: $1,115.32 (Don't know where this comes from)

We are pretty ecstatic! Do I have to worry that they might change their minds?

Under "Description of Service", it says "Not Available". Is it possible that they don't realize it's related to the ADR?

(Mr. Staci70)

[staci70]

Surgeon has now been paid.

[DaddyO]

Thanks for sharing. I live in Florida and my surgeons office has said BCBS most likely will not cover it. They are still trying to see if they will though. I'm praying.
Where did you have your surgery? What surgeon? My surgeon here is planning to send me to Denver.

[wgnmn]

My Dr. went to bat for me for a 2 level cervical adr and was of course denied. He explained to me that since the Health-care Bill was shoved through, Ins.'s are denying as much as they can. They don't want to pay for anything unless they think its absolutely necessary. So everything is going to be in limbo until 2014.Many of the Dr.s are in agreement he said, that the way the bill stands, many Practitioners will have their income cut in half and have to lay off 50% of staff. Some are seriously considering giving up their practice. See how long you'll have to wait for answers, appointments and procedures then. The Specialists alike are kind of freaking out he said and really ticked off. I watched on CSPAN when the Senate voted on the bill. Unbelievable is all I'll say.
I am also praying for Gods answer to how I'm going to finance this. It has to be done soon, I can't work anymore and I have a lot of work lined up.

[Ramen]

Thanks for sharing. I also have BCBSFL and I was told by my surgery scheduler last week at the doc's office that they still consider it "experimental" and asked if I wanted to switch to fusion. I said fight it.

Still playing the waiting game.

[Lauren]

Hi Staci - I am appealing to my insurance for the 2nd time. I am seeking the names of people who have been paid for ADR, their surgery date, surgery location, physicians name and insurance name. Would you mind providing that information? I'm building a list to prove to my insurance that ADR is becoming a standard medical practice. Since the FDA does not approve surgical procedures but rather the tools that are used in surgeries, I am appealing on the grounds that this is not "experimental". Providing precedent set by other insurance companies will help my case. I imagine that any one of us having to appeal a denied claim could use the same information. Could we build a list that lives here on the ADR site? I know I'd be happy to add my name to it, once I've been paid.
Thanks for your help!
Lauren
PS If you email me privately, I'm happy to provide any further info you might want. lauren@workinggreen.org
Thanks again.