Anesthesia Pre-Auth Denied for Approved Outpatient Procedure (Anthem)

Here’s a first for me… I’m scheduled to have an outpatient medical procedure (colonoscopy screening) this week (which will likely have to be rescheduled due to this snag). Today, my provider contacted me to inform me that the customary anesthesia for my procedure was not approved and that I’d need to pay them for it out of pocket.

I’m not inclined to pay out of pocket for something that should be covered by my plan, so I phoned my insurance (Anthem Blue Cross California). The rep I spoke with confirmed that outpatient anesthesia is fully covered under my plan and they had no record of a pre-auth request for the anesthesia (just the procedure itself).

Confused, I called the provider back and they informed me that my insurance uses a third-party approval service called AIM (pretty sure this was the name), and that AIM has an extremely rigid set of requirements which I do not meet for approval of anesthesia for this procedure. Obviously, I found this to be an unsatisfactory response and have filed a request for further support through an advocate program provided by my employer — they’ve helped me work through issues like this in the past.

Has anyone experienced something similar and if so what was the resolution? I think it’s totally bizarre that they would approve the procedure but not the customary anesthesia. TIA.

submitted by /u/brianonthescene
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