The most confusing phone call of all time

I called BCBS again today. I know, I know, I’m going overboard. I just wanted to make sure that everything had been received and is under review.  I spoke with Brian F., the original Brian who faxed my policy to the surgeon’s office about two weeks ago and let me just say, my conversation with him was totally confusing. I explained why I was calling: just to be sure my case had been submitted to a nurse or case manager for pre-determination and that it was under review. His answer: “well, yeah, we just received everything Tuesday and it will be 30 business days before we send a letter to your provider. But just so you know, pre-determination doesn’t mean we’ll pay for anything. It just means we agree that the services they will provide are covered under your policy.” So I say, “so… that means you could confirm that I qualify for the coverage, but then deny the claim for payment?” He said, “well yeah, but it all depends on how the surgeon’s office bills the claim. If the claim says you had gastric bypass because of an itchy nose, we’re not going to pay for it.” So I said, “all right, well I’ve heard of people being denied coverage. If this is just about complying with the policy, which I know I’ve done, then is there a chance I could be denied?” He said, “Yeah, absolutely!”

I’m so confused. This process takes like a month and a half, they can approve or deny you, and then that has nothing to do with actual payment? What the crap?

I just need to stop calling and wait the freakin’ 30 days. Just for the record, 30 business days from Tuesday lands on freakin’ December 12th. Then we have to wait for the letter. Then surgery is scheduled a month and half out which is now freakin’ February!

Deep breaths.

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3 Responses

  1. I’m thinking you need to call and speak with a supervisor! I don’t think Brian acted very professionally at all and I’m a stickler for professionalism! C’mon, why the frick would he even think your doc’s office would bill it incorrectly? Me thinks Brian is an assboobie.

  2. assboobie is my new favorite word!

  3. […] called the surgeon’s office. I called BCBS back to see if they would fax the approval letter (the jerk from the other day answered and said NO). I called the surgeon’s office back.  She has to […]

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