"Blue Cross and Blue Shield will make the decision whether hospitalization or other health care services or supplies were not Medically Necessary and therefore not eligible for payment under the terms of your Policy. In most instances this decision is made by Blue Cross and Blue Shield AFTER YOU HAVE BEEN HOSPITALIZED OR HAVE RECEIVED OTHER HEALTH CARE SERVICES OR SUPPLIES AND AFTER A CLAIM FOR PAYMENT HAS BEEN SUBMITTED.”
I've read in the Chicago Tribune that some people have had claims denied even after going through the proper pre-approval procedure. The policy isn't 100% clear on that, but this clause sure seems to say that even if I get the proper pre-approval they could deny my claim if they deem the procedure "medically unnecessary! No wonder people with insurance still end up declaring bankruptcy!