Karen,
If BCBS is telling you that it should be covered and is miscoded, try to find out what code it should be and send bill back with a letter requesting that they correct it and don't pay it until they do.

The hospital should have precertified all pre-surgery tests. If they failed to do so and that is the reason it is not being covered, then it is not your responsibility.

Floride trays are dental and floride treatments not covered for adults. I don't know anyone who has gotten these covered. There is usually a maximum for PT a year. If he hasn't exhausted that, find out why it is not covered this time and what you have to do to get it covered. This should have been pre-certified also.

As to social worker, visiting nurse and nutrtionist, I would think all should be covered. Have they given a reasonable explanation as to why they are not covered?

I wouldn't pay for anything other than the floride trays until someone shows me where in my contract that it says this service is not covered. Yes, it is about codes. Both the code for the procedure and the code for the diagnosis. If either is in error, it won't get paid. Hospitals have to correct these all the time. Don't let them tell you, they can't. It just takes time. And don't worry about the collection agency. They can't ruin your credit for unpaid medical bills. Send them a copy of the letter you sent to the hospital to request the correction, and they should leave you alone.

All this takes time and a lot of patience but it does keep the money in your pocket and eventually they get paid or write it off. Meanwhile the computer will keep sending you bills just to annoy you more.

Take care,
Eileen