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Blue Cross “found” The Pre-Approval Number

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July 11th, 2015 Posted 3:15 pm

The kind people who deal with collections at the office where I had my PET Scan offered to submit an appeal for me. In the process of getting the appeal information together, one of these kind people called Blue Cross again. The woman called me later the same day to tell me the good news: Blue Cross was processing my claim. This was such a relief, and particularly great news given that it came a couple days before Christmas.

If you read my previous post, you’ll recall that my doctor’s nurse obtained a pre-approval number for my PET scan. Blue Cross should have processed the claim, but they told us that a pre-approval was never submitted. The Blue Cross representative, interestingly, asked my husband if we had the pre-approval in writing. Though they told him that they always send pre-approval letters to patients as they are processed, I have yet to receive one. I’ve had multiple MRIs and CT scans, but I have never received a copy of the pre-approval from Blue Cross.

During my phone conversation with the woman from collections, she told me that she had to pressure the Blue Cross representative for some time. Eventually, the Blue Cross representative admitted that they DID process the pre-approval for my PET scan. They had simply “misplaced” the documents involved with the pre-approval. I also learned during the phone conversation that Blue Cross regularly claims that they didn’t process pre-approvals for expensive tests like PET scans. (The bill for my PET scan was over $4,000.)

I’m confident that Blue Cross didn’t “misplace” anything related to my pre-approval. I’m confident that Blue Cross LIED. Blue Cross LIED to us on the phone when they told us they had no evidence of my pre-approval. Blue Cross LIED to my doctor’s nurse – – the same nurse who, God bless her, obtained the pre-approval and recorded the pre-approval number – – when she called on my behalf. Blue Cross LIED to the woman from the collections office during multiple phone conversations. I’m confident that Blue Cross is LYING to other patients about their pre-approvals right now.

If you have had a pre-approved claim denied by your insurance company, don’t be discouraged. Get the pre-approval number from the doctor’s office who ordered the test. When you receive the Explanation of Benefits (EOB) from your insurance company indicating the claim’s denial, call your insurance company and provide the pre-approval number. Ask for the name of person you spoke with – – always get the name of the people you speak with on the phone – – and write it down. Document the date and time, along with the conversation itself. If the insurance company still refuses to process the claim, call the office where the test was preformed. Provide them with the pre-approval number, and ask if they would be willing to contact the insurance company on your behalf. If you have to submit an appeal, ask the office if they can assist you with it or submit it for you. If you have to submit the appeal yourself, call your insurance company to find out what they require in the appeal and when the appeal has to be submitted. If you have anything to add to this, please leave a comment. 🙂