HELP - BCBS Denying a part of my revision

NSWTD- So sorry you are going through all this.  As if having BC isn't bad enough without having to deal with the financial nightmares that sometimes come with it.  First of all, was the fat grafting done by your BS or your PS.  Just curious because this is usually something the PS's do.  BS's usually just do the MX itself.  Also, is it your doctor's billing office that is saying it isn't covered or is it your insurance company?  I just had a revision as well where they did fat grafting and it was covered 100%.  I do know that a lot of times when things aren't covered it is because the doctor's office is not using the proper billing codes.  The problem is almost all PS's do boob jobs and lipo suction but they also do breast reconstruction and fat grafting.  These need to be coded and billed differently because one is elective and the other is not.  I believe my PS billed the actual fat grafting as "breast reconstruction using different method" or something like that.  The first step would be to find out how the doctor billed the procedure and the second would be to call your insurance company and talk to a supervisor about this.  It is a federal law that insurance companies have to cover breast reconstruction even if it is a revision.  Don't give up, yet.  Right before my revision my PS's billing office was telling me that my replacement implants were not going to be covered and they wanted an additional $1500.  It took 50 phone calls but I finally discovered that they weren't submitting the claim correctly.  Two days before my surgery I found out it was, in fact, covered.  Good luck and sorry you are having to deal with all this. 

I agree with Kate, could be a billing code issue.   Legally, I am pretty sure revisions for mastectomy need to covered. 

Pay what you can afford on the bill until it is paid.  They cannot charge interest, from what I have been told but not verified.

VJSL8- I found this-

This is interesting- I wonder what definition of "match" they use? Matching in clothes is one thing, matching when undressed it a whole different thing. For example, I match pretty well in clothes with or without a bra- but undressed i have bothersome rippling on the reconstructed side and the nipple which is a skin graft definitely needs work- this is after a redo of my first reconstruction- I went out of pocket on all of it anyhow because the better PS's in my area (San Diego) don't even participate with insurance!

Don't get my started with Blue Cross & Bull Shitsheild. They will deny anything and everything. It's all about your doctor finding the correct code.

Denied my blood draw for the BRCA test ($25) but covered the actual BRCA test
Denied the PS portion of my BMX with tissue expanders
Denies my blood draws to check my estroil level ($11) every 3-6 week but covers the actual test
Just denied my gyno exam but is covering my pap smear

First 3 I did get covered. My gyno is recoding my exam so I'm sure that will be covered too. Seriously a breast cancer patient not getting a physical exam by a gyno covered. Are these people on crack? No they just don't like to part with their money.

It was a coding issue. Believe me the office was telling them it was a law. There are several problems. First the Shitshield I was using was from another state so they had different codes rules then IL. The other thing I notice is shitsheild seems to be changing things every year. The issue was that my PS office put the general code for reconstruction but they wanted the code for TE placement.

Actually I do feel they would try to get out of paying for penis reconstruction too.