First off, they tried to deny approval for the surgery as they deemed it not medically necessary. It was a surgery to correct a growth that did not align with my child’s genetic sex. In the policy manual, they will approve “gender affirming surgery.” How is removing a growth that does not align with their genetic sex not “gender affirming surgery?” They repeatedly denied the surgery both times it was scheduled and only finally approved it 24 hours before surgery and only after one of those peer consultations we’ve been hearing about. Fast forward to billing and 5 months after they are refusing to pay the surgeons fee. I called BCBS 6 weeks ago and spoke with someone for 15 minutes who said there was an obvious problem with the denial and she would fix it and the bill would be paid, I just needed to affirm on the phone that I have no other health insurance. I did so and we completed the discussion.

Well, I got another bill and it’s about to go to collection. Mind you, they have paid all but $1166 of a $62,000 bill (f’ng completely outrageous) and they are dragging this out. I called again and this time, whoever I got is taking their sweet time helping me. They claim they can’t find the claim, this takes 15 minutes, then the guy sends it for review by the “claims department” this takes nearly 45 minutes for him to affirm that the claim is fucked up because they say I need a Medicaid denial when all I need to do is affirm I have no other health insurance which I did online while on the phone. He spends a lot of time saying I’m asking for an exception to their rules. Of course I’m not because most of the bill has been paid without this additional paperwork they want from Medicare, which I do not have and we go back and forth about this. He also wouldn’t let me do the verbal verification over the phone which is also possible. The whole encounter was 1h17m and I still feel like this guy was fucking with me. He told me at one point he had a whole department of 3 people researching my issue. I call BS and think he was fucking with me. I want to call next week and lodge a Complaint against Sergio and his inappropriate treatment of my inquiry. I would appreciate any guidance as I am at my wits end of why I have to justify that I don’t have Medicaid when most of the money has already been paid out for this surgery.