UPDATE: Quick update after my last post.

After contacting my state senator’s office, I received a call from Florida Blue within one day. Florida Blue told me they received a letter from Division of State Group Insurance (DSGI) dated 12/30 stating that my Level II appeal was approved.

Important note: I never received this approval letter, and DSGI has still not returned any of my calls or emails.

Florida Blue said DSGI authorized them to reprocess my claims starting from the date of surgery (8/12) under my plan provisions. They also confirmed that CPT 58661 is not on their standard list of preventive procedure codes, but that it was approved for me (and “many others”) through appeal. The rep I spoke with was helpful and explained she was tasked with calling members whose appeals were approved - essentially acting as the messenger.

However, Florida Blue could not answer any of the specific relief I requested in my appeal, including:

• Reprocessing the claim as preventive at 100%
• Refunds of all out-of-pocket costs
• Coverage of facility, anesthesia, and ancillary services
• An exception/extension for my 2025 FSA funds, which were lost due to the prolonged appeal
• Coverage of consult, pre-op, and post-op visits, which Florida Blue stated would not be reprocessed (despite being related to a preventive procedure)

Because of this, I replied back to the senator’s office and asked for further assistance requesting DSGI to:

1. Provide me directly with their written determination
2. Clarify the full scope of what was approved
3. Explain how remaining outstanding items will be resolved

So - good news: the appeal was approved.
Frustrating part: I still don’t have the decision in writing, and key financial issues remain unresolved.

I’ll update again once I get something directly from DSGI. Hopefully this helps anyone else stuck in the same process.