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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #1  
Old 02-01-2014, 10:58 AM
Surprised 1 Surprised 1 is offline
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Join Date: Aug 2013
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Default What next?

Just received BCBS decision on reimbursement for my surgery in Germany. While they "allowed" the full amount billed they denied reimbursement because "Service provided without authorization." So, I am looking for advice on how best to appeal this decision and would appreciate any insight. Thanks.
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MRI shows C5/6 & 6/7 DDD along with lower cervical kyphosis
Recent onset of some arm numbness
9/03/13 2 level M6 ADR's C5/6 6/7
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Old 03-14-2014, 05:37 PM
bwink23 bwink23 is offline
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Did you call to verify coverage at all with BlueCard WorldWide before surgery?
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2013 - MRI and CT scan....DDD L4-S1
left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement

Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine.
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Old 03-18-2014, 08:29 AM
Surprised 1 Surprised 1 is offline
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Quote:
Originally Posted by bwink23 View Post
Did you call to verify coverage at all with BlueCard WorldWide before surgery?
Yes, in fact, they even sent me the claim form to send in after surgery. Turns out that the "international" division of BCBS just converts the currency to USD and then sends the information to one's home state. I let you know if I get anywhere with appealing...
__________________
MRI shows C5/6 & 6/7 DDD along with lower cervical kyphosis
Recent onset of some arm numbness
9/03/13 2 level M6 ADR's C5/6 6/7
Reply With Quote
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