Wednesday, June 6, 2012


This wouldn't be a real surgery without a little "runaround" by an insurance company (only true in the U.S., of course). I had mentioned in my last post that my surgeon's office had re-submitted my case for pre-approval with my insurance company (Anthem Blue Cross). I received the approval letter on Monday... yay!!! I skimmed it and saw phrases like: "medically necessary" and "certified" and "You have chosen to receive services from a provider that is a non-participating network provider. Your services could result in significant out-of-pocket expenses."... say WHAT? I immediately called them, was on hold forever and the first agent I spoke to said "the doctor is contracted in New Hampshire, but your policy is California. Sorry." Without going on and on here about all the different people I spoke with and all the different things they told me, I will fast forward... The last person I spoke with assured me that my policy DOES cover out-of-state "in network" doctors. I finally got a hold of the department that issued the letter and they looked up my doctor while I was on the phone with them and agreed he is, in fact, "in network". (They had his first and last name mixed up, Henry Charles, rather than Charles Henry which is why he wasn't listed as a provider!) They've re-issued my letter and it't in the mail... So, to make a long story longer... I'm approved and my insurance will cover it!

So here's the breakdown with descriptions as they are written on my letter:

reconst lwr jaw w/fixation - Approved
reconstruct midface lefort - Approved
prepare face/oral prosthesis - Approved (splint)
excise inferior turbinate - Approve (deviated septum... i can't breath from my right nostril) 
1 day hospital stay - Approved 
2 additional days - NOTApproved

So, my insurance company will cover 70% of my surgery. I am responsible for 30%. HOWEVER, my maximum out of pocket amount is $5800, so that's the highest cost they can bill me for. 


  1. Insurance issues are so much fun, right? You are lucky u found someone in-network. I have blue cross, too, and there are zero dr's in-network in my state. Good luck w/ your surgery! Mine is next month.

  2. Hi Erin! I just found your blog and am excited to read it. Seems we have similar cases. Good luck with surgery. I'm looking forward to following your progress!

  3. Great news! until I got to the 'approved' part of the post I was panicking while reading!! haha. CONGRATULATIONS and I cannot wait until you are on the other side :) miss you lady. we'll have to get drinks/apps before surgery time for sure!

  4. Wow Amanda, I can't imagine what a pain that is to have to deal with insurance and worry about approval.
    Up here in Canada they didn't even ask if it's necessary or anything. It's sort of just automatically covered by OHIP.
    We pay surgeon fees though for surgical planning and it's a couple hundred for a private room.
    Congrats on getting approved :D

  5. In the big scheme of things, $5,800 isn't too bad. And the hospital can put you on a payment plan once you receive your bills. It will be so worth it in the end! Glad things are lining up for you.

  6. Thanks ladies. It's amazing to know that the final hurdle is out of the way. Yikes, getting excited!

  7. That's great news! I was so relieved when I found out my surgery would be covered.

  8. Congrats Amanda! Here's a meme, I feel those of us approaching surgery needed one :)

    1. Ha, thanks Jocelyn! PS, you know I LOVE the gifs on your blog.

  9. great news amanda, won't be long for you now!