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BCBSTN Denies Sleep Apnea Surgery

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CalmVioletHamster5920 +0 points · over 8 years ago Original Poster

"Your doctor asked us to decide if 30520 Septoplasty, 30140 Submucous resction inferior turbinate, 42826 Tonsillectomy for treatment is covered by your health plan.

Based on the terms of your health plan, BlueCross BlueSheild of Tennessee did not approve the predetermination for:

septoplasty and Submucous resection inferior turbinate indicated for nasal obstruction when patien has received maximum medical treatment for symptoms and tonsillectomy is indicated when concurrent uvulopalatopharyngoplasty is being proposed for treatment of tonsillar hypertrophy and mild sleep apnea."

So, I just received the above letter. I haven't spoken to the doctor/hospital, yet going to the best 'hospital' in Middle TN. The doctor told me I would getting the UPP surgery and a septoplasty.

Any way I could an appeal? My deviated nasal spectum is actually from a car accident, and the surgery I had, I guess didn't correct it fully ten years ago.

They also state I have mild sleep apnea, when it is actually severe sleep apnea.

Or would I not have a chance at an appeal.

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DanM +1 point · over 8 years ago Sleep Enthusiast Support Team

Hi @CalmVioletHamster5920. I would encourage you to speak with the physician that requested the authorization from your insurance company. Based on my own experience with insurance, including BCBS (not TN, however), denials are not uncommon. Your physician may need to provide additional and/or corrected information to help justify the need for surgery.

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