Reply #125: Try looking up their agreement

[pecwae]

with the provider of the surgery. Those terms can hold the provider responsible whether the procedure is deemed medical necessary or not by the insurer as long as the patient did not sign a very specific waiver stating that he understood BCBS might not pay.

It happened to me with an expensive scan. BCBS of NC told the provider I didn't need precert. I signed the generic paperwork the day of the procedure. A month later I got the EOB with denial due to medical necessity. After a few months of back and forth the provider had to eat the charges because they were in violation of their agreement with BCBS.

Good luck!