Problems with Blue Cross Blue Shield insurance company?

Well, because they're running a business. If you were the insurance company shelling out hundreds of thousands of dollars, you'd want to make sure that you were liable for the charges. They are only going to pay for things that are medically necessary. Most likely, the doctor didn't supply enough information to show that this is medically necessary. They would have given the dr specific reasons why it got denied, and if those reasons are able to be argued based on more information from the dr, they can submit that in an appeal.

Blue Cross has so many plans. Sounds like you got one that is cheap for the company you work for and passes their savings on to you. I have the Blue Cross 105 federal govt plan and it's ok, been downgraded over the 24 years I've had them though. Yous is most likely better than nothing, but management told HR to cut the costs. There are options. Depends on how upset the employees are. A few of you guys could bring about a change. Companies have health care offered to keep employees not to upset them and cause them to look for jobs elsewhere. I work with this stuff as a paid benefits educator in Florida and Georgia. Blue Cross can have options offered to you, which will give you a choice on what you want to pay and have paid. The company is looking at the bottom line. If they offer Blue Cross Options Plan, the company still pays the same amount. You make a choice and pay the difference, usually not a lot. If they offer a supplimental insurance company, you get a free educator, such as myself, and the company gets a tax break (IRS 125 is the law) and you get a discount by getting a tax break yourself. I work for Colonial ( they started this stuff) , there's AFLAC, and a few others out there. If they don't offer one, they should. They can change insurance companies tomorrow, if they want to do so. They are not locked into a year, as some will try to tell you. If they are using AFLAC they can open a Colonial plan or vise versa. Change the carrier and it all changes. They can offer United Health Care along with Blue Cross and a dozen more plans, if they choose to do so. A few of you guys can make a change in a month, if you want to go through the trouble to do it. If you're young, look into the new HSA plans, very nice tax sheltered annuity. The tax shelter works as long as you use the money for health care. I suggest this plan for the state employees here, who will have to pay 100 % of their health care costs when they retire. They still get to stay into a group, which costs less and they can be insured. Some folk in life can't buy insurance as thir health is too bad. My suggestion is. Get a few of the other employees together and call Colonial Supplimental, AFLAC and AIG Those are some of the larger education companies here. If a used car salesman shows up, call one of the other guys haha There are options out there. I'd use them and have. I've been a union member for years. One of the reasons for them. To improve working conditions and educate the employees.

1st off, call BCBS and ask why they are denying?

Do they believed not needed or have other suggestions on treatment?

Do they have a pre-existing clause that states not covered? some policies have an 18 month to 2 years clause that states if discovered, not covered.

2nd call the surgeons office and have them get involved. your surgeon may need to send them a report outlying the reasons of the needed surgery. if for instance they state no surgery needed that your husband can do just fine on meds. that wont fly, since taking high doses of meds can be addicting. also pending their decision, make sure the doctor keeps prescribing pain meds.

if they still fail to authorize, find out what the appeal process is.

you need to understand that the person who denied is not a doctor, only a person who pays claims and denies. they do not have a medical background.

also; no matter what; do not have surgery until they authorize this. if not, the surgeons office will bill you. they will not fight after the fact for their money, since you will have signed an authorization to be financially responsible if your insurance does not pay. that is the reason they wont do surgery until you sign it.

if unable to not have surgery, then ask the surgeons if there are other options;

ie; pain injections;

health insurance companies do their darn-est to deny claims so they can save money and make more profits. some companies have rewarded employees for the most claims they denied. case in point was healthnet got huge fines once proven they paid employees bonuses after denying claims and rescinded policies leaving many people hanging dry.

good luck

sometimes when you buy a policy they come with specific riders and provisions, did your husband have back problems already before he bought this insurance? if so its considered a pre- existing condition and insurance companies have the right to waive coverage for any treatment regarding that condition usually for a certain period of time (usually after 2 years of coverage) however sometimes they can put it in the rider that this particular condition will not be covered, (not sure if they can do it permanently thought), so you might want to take a look at your policy and see if it says anything in there about that, and if you have had the coverage for less than 2 years but hubby has been having back problems since before that, chances are it wont be covered at least until after a certain amount of time has passed.

Have your doctors appeal the decision and keep on them until they get approval.