I got an exception to coverage for a procedure at Stanford medical center that is next week. I’ve been waiting over a year for this appt. Now Stanford is saying there’s an additional CPT code that was left off the authorization. What can I do to not have to reschedule?

I have been waiting for over a year for automomic testing at Stanford. The procedure includes a testing date and a office visit separate from the testing, currently scheduled on two days back to back. These are both a part of the testing process. Stanford is out of network with my insurance, covered CA blue shield.

I got a gap exception from my insurance for autonomic testing, and they approved all of the codes for the testing date. But somehow the doctor failed to communicate that there was another code for the consultation and that was left off of the authorization, even though I double checked to make sure all necessary codes were on there; by calling the Drs office and asking which codes they used and having my blue shield nurse case manager reach out to the Dr. Two new codes were added after I double checked this way, that were not on the first authorization letter. But somehow the code for the office visit after the testing was left off.

Now both appointments are in one week and I’m missing this one code. I left a message for my case manager and for the Drs office to add the code, but I’m worried it won’t happen in time. I would need to reschedule by Tues morning if I have to.

Is there anything else I can do? Will blue shield pay for the code after the appointment if I file a grievance? Or will they just blame the Dr for not putting all the right codes in?