BCBS Precertified Neurosurgery
Question Details: In March, 2008 BCBS precertified cervical neurosurgery (prior to undergoing the preop physical I was shown the precertification number by the hospital and my neurosurgeon also commented that the insurance company precertified the surgery in record time). I had no choice regarding having the surgery. February, 2009 I was informed that BCBS reneged on the payment due to the fact that they said the PRESTIGE artifical cervical disc was deemed investigational (it is FDA approved then and now). A collection agency is threatening me with suit for the almost $13000.00 bill. What is my recourse
Insurance Law Law Answers
I'm afraid the only way to deal with this is hiring a good lawyer, to not only defend you against this claim, but quite possibly to threaten the insurance company with a suit for failure to deal in good faith, if the detailed facts of your case justify something like that.
The law ordinarily protects people who act with "justifiable reliance" on the actions of others, actions intended to cause people to act in reliance, to those people's detriment. Whatever the medical situation, you had the right to know, one way or the other, whether BCBS would cover the surgery, before you went ahead with it.
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