BCBSTX "cannot advise" if a service will be covered or not ahead of time.
So, I’m at the tail end of having my face reconstructed. BCBSTX has covered this whole process (five surgeries, all the tests, ICU time, everything). The last step is dental reconstruction. I need a prosthetic that will function as teeth and gums on the upper left side of my mouth, anchored by dental implants. I was told that health insurance usually covers everything but the prosthetic for situations like this. Turns out that’s not true. They denied pre-auth. Was told by the billing person at my oral surgeon’s office that they would likely still cover anesthesia and hospital fees even if they wouldn’t cover the actual procedure. That sounded weird to me, but it was at least worth looking into. Today I get a call from the oral surgeon’s office again. Insurance didn’t deny or approve. They told me that they “cannot advise” whether or not they’d cover this. Is that allowed? Can they just leave me in the dark like that? I can’t take the risk and go ahead with this surgery if I don’t have any idea how much money I’ll owe beforehand. Do I have any recourse? What do I do?
