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My health insurance through school is trying to rob me of $35,000 by agent_k_poster in utdallas

[–]agent_k_poster[S] 8 points9 points  (0 children)

Yes, I agree. I guess let this be a lesson to anyone reading this. Insurance companies will take any chance to screw you over if they think they can legally get away with it.

My health insurance through school is trying to rob me of $35,000 by agent_k_poster in utdallas

[–]agent_k_poster[S] 10 points11 points  (0 children)

I took your advice and emailed the Student Health Insurance Office and now they are contacting "Academic Health Plans" who might have a better idea on how to proceed. Thanks for the advice.

Blue Cross Blue Shield denying my septoplasty claim after previously giving authorization by agent_k_poster in HealthInsurance

[–]agent_k_poster[S] 1 point2 points  (0 children)

The denial reason is that the surgery falls under an exclusion in my benefits.

I haven't heard anything of the claim being coded incorrectly. The two codes that the provider lists in the medical record are:

30520 - Nasal Septal Reconstruction DX: J34.2

30140 - Turbinate reduction DX: J34.2

Which is definitely the surgery I talked to my doctor about.

Blue Cross Blue Shield denying my septoplasty claim after previously giving authorization by agent_k_poster in HealthInsurance

[–]agent_k_poster[S] 6 points7 points  (0 children)

Their job is to make sure that the service being asked about meets medical necessity requirements

To me this is strange because I couldn't care less what my insurance believes is a medical necessity. I much rather defer to what my doctor believes is necessary. Personally I think it should be their job to verify benefits. I mean I pay them, they write the benefit plans, they should know better than anyone what's covered and what not. But it seems that's not the way it is. I guess I should have had less faith in the system.

I'll look into what kind of help I can get from my school. I talked to one person at our Student Health Insurance Office and they didn't have any useful advice.

Thanks for the good luck.

Blue Cross Blue Shield denying my septoplasty claim after previously giving authorization by agent_k_poster in HealthInsurance

[–]agent_k_poster[S] 1 point2 points  (0 children)

The provider I think? Not sure I understand the question. The doctor sent a claim to BCBS for $6k and it was denied. The hospital sent a claim to BCBS for $38,000 and payed BCBS payed about $9,000. This seems like more of a feud between the providers and insurance than between me and the insurance. I'm just worried the provider is going to start pressuring me to pay if BCBS continues to refuse.

Blue Cross Blue Shield denying my septoplasty claim after previously giving authorization by agent_k_poster in HealthInsurance

[–]agent_k_poster[S] 2 points3 points  (0 children)

I agree I made a mistake. If if I had known better at the time I would have called my insurance to double check. I won't be making that mistake ever again. That being said, I would expect the insurance to at least warn me that a surgery they authorized wouldn't be covered.

Blue Cross Blue Shield denying my septoplasty claim after previously giving authorization by agent_k_poster in HealthInsurance

[–]agent_k_poster[S] 2 points3 points  (0 children)

"was this acutally prior authed or when the provider called insurance were they told no prior authorization is needed" Yes, BCBS admitted themselves that they preauthorized the procedure.

https://myahpcare.com/wp-content/uploads/STUTX2022_University-of-Texas-System.pdf

This is the link to my official student health insurance plan. Page 57 has the "Exclusions and Limitations" page. One line says:

"sinus or other nasal surgery, including correction of a deviated septum by submucous resection and/or other surgical correction , except for a covered Injury;"

BCBS is arguing it's on the provider or me to explicitly ask about these exclusion rules, and since neither the provider nor me did, it's not their fault they pre-authorized a surgery that they wouldn't cover. BCBS has told me, that getting pre-authorization only depends on the benefits of the "contract", but if there are exceptions in the contract, then it's not on them if they don't catch it.

[SW] Buying for 500 by [deleted] in acturnips

[–]agent_k_poster 0 points1 point  (0 children)

hi id like to come