Dr. Albear’s office called today after receiving a reply from BCBS regarding their submission for pre-determination of my brachioplasty and mastopexy. The insurance coordinator said that BCBS’s response was “we don’t do predetermination on those procedure codes.”
So. That means you must have the procedures first and then submit the claims. And undoubtedly get a denial. And then appeal. And then get denied again. And then ask for a review. And probably get denied again.
Dr. Albear’s office knows this game, so the coordinator said “we would need you to self-pay, then we would submit to insurance and reimburse you if the claim is paid.”
And I think to myself, what motivation do they have to help me fight for an appeal if they’ve already been paid in full? Especially if getting insurance payment means getting less money since we all know the negotiated in-network costs to BCBS would be far less than I’d pay as a self-pay client.
On top of these realities, I have to be totally honest: I do not have rashes. I do not have fungus or smells or any of the other creepy stuff I’ve heard people complain about. I just have loose skin. In my personal opinion, this is reconstructive. But I don’t have a medical case for that.
So I’m officially self-pay. This is no surprise.