My friend needs back surgery for a ruptured disk and other serious issues with her back. She has had (2) recommendations for surgery from two surgeons. However, the BCBS policy she has through the federal health exchange has denied covering her surgery. She has had the back problems for a long time, but I didn't think they could deny her for pre-existing conditions anymore. Or, is this just SOP for insurance companies to deny surgery so you have to appeal? She is really upset because she was waiting for ACA to get her back fixed. Does anyone know where she can go to get help?
What was really disturbing is that her doctor told her she would be denied because her insurance was through the exchange. He also told her that he only gets 5% of his fee paid from insurance through the exchange. So the question is why would he accept her insurance at all? Or, why would he do surgery on her if he knew he wasn't get 95% of his fee? I don't know, it just sounded fishy to me that he knew she'd be denied.
Any guidance on where she can go to get help for an appeal would be appreciated.