Approved or not???

[Sheila 0]

I received a letter from my insurance (Anthem Federal) that has me totally confused. It states "This is not an approval for claims payment. This approval is a confirmation of medical necessity only" yet it goes on to say "Based on the information provided to us, we are pleased to authorize the inpatient admission referenced above" The reference is an internal Anthem number, so doesn't really tell me anything. There isn't any other procedure codes or anything on the letter. I am waiting to hear back from my surgeon's office to see what they say before I call Anthem again! Just wondered if anyone else has received this kind of letter.

[Lioness81970 0]

Hi Sheila - it sounds like the same letter that I received. When I called UHC they said that is the standard letter that goes out when they are issuing a pre-authorization. The person that I spoke to said that the reason they state it's not an approval for claims paymnet is because nothing has been done yet so they can't authorize payment until the actual surgery has been done - that is where the claims part comes in. Hope that helps.

[Sheila 0]

Hi Carmen,

Thanks for your reply. That is encouraging!! Hopefully it is an approval and I'll be good to go. I've already met with the surgeon, nutritionist and had my psych eval. I am so ready to get banded and join those in bandland!!

Sheila

[bbrecruiter2000 1]

Sheila,

Most insurance companies have a pre-certification process which is handled by a third party vendor. My insurance required I establish medical necessity with a company called Health International. The vendor outlines the criteria given to them by your insurance company and then they give you the criteria and if you meet it, they send it over to your insurance co with a recommendation that the surgery is medically necessary. It has been officially preauthorized, which means that letter was forwarded to your insurance co and that is officially an approval and is adequate for your docs office to move forward. COngratulations! You are on your way to being a bandster!!!!!

Babs in TX

334/263/180

-71 and counting

6/23/03