3 replies to this topic

[Tana_Q]

So all my pre-op stuff was finally done and ready to be submitted to insurance today.  The surgery coordinator called me around 4 to tell me something strange.  She said she called Empire BCBS and they told her with my plan that no precert or authorization is required for anything as long as it's covered (it is).  She said she has never encountered that in 6 years of dealing with insurance companies.  So she had me call BCBS as well just to make sure.  They told me the same thing when I called, that I don't need any auth. for even things like an MRI!

So I now have a surgery date and hoping that this doesn't bite me in the end!

Has anyone else had this happen?

[mistymee]

I've seen it happen once or twice, but I'd want that 'no precertification necessary' in writing... like you said, you don't want it to come back and bite you in the behind.. could be costly.  

Good luck.

[Martee]

My insurance was like yours (I have CHAMPVA); however, my surgeon's office still sent in the paperwork...just to be certain.  

Funny thing is, I provided my surgeon's office with a copy of the CHAMPVA policy that outlined the exact procedures they reimbursed and my surgeon performed a procedure that was NOT covered.  I was sweating bullets when I received the EOB, indicating it wasn't a covered procedure; however, I contacted my surgeon's office and, after waiting several days to hear back from them, found out that they wrote off the charge since it was their error.  Talk about relief!  Whew...

I would recommend you find out the CPT code for your planned procedure and verify it is covered by your insurance company.  It's always best to be safe than sorry.

Best wishes as you continue your journey towards a healthier you!

Edited by Martee, 09 February 2012 - 08:55 PM.

[Tana_Q]

Thank you both.  I did verify the CPT code with my insurance on 2 separate occasions as did my surgeon's office.    I know they do pay for it I was just perplexed by the no pre-cert thing.  No matter what happens I will be worried until that EOB shows paid!