No Precert Required?

[Tana_Q 20]

So after all the hassle of the pre-op appointments my insurance apparently doesn't require a pre-cert or authorization! My surgeon's office said they have never had that happen. The coordinator even asked me to call my insurance to double check. Nope, they don't require any pre-certs for ANYTHING. Not for surgery, hospital admissions, MRIs, nothing. I also made sure that the procedure is covered by giving them that code. It is so I now have a date.

Just curious if anyone has experienced this with their insurance? I know that usually people are trying to fight to get it approved so this is weird!

[Ms skinniness 3,003]

CONGRATS! This surgery is ment to be. My insurance made me jump through hoops,

[Amanda 3.0 140]

Well, you checked and double checked, so you should be good. That's awesome! I don't think one can really do too much preparation for this surgery, so the pre-op appointments may have been a good thing, although unnecessary!

About seven years ago, when I was considering the lap band (didn't go through with it), our insurance did not require precertification for anything, unless it involved an overnight hospital stay. That isn't the case now, but apparently some plans are like that. So many employers are self-insuring now, that they are just using the networks and putting their own requirements in place. Our current insurance plan is over the top fussy about things, for example I had to take multiple blood tests to prove I don't smoke!

It is crazy how different all the plans are.

Edited, because I couldn't see your sig with your surgery date when I was replying to your post! Congrats!

[Pookeyism 1,143]

Call and ask to speak to a case specialist and ask them to direct you to the part of your policy that says that you don't need any of that, and get your correspondence in writing from there on - also get a regional mamagment clearing stating they will cover your surgery.

Even if they somehow manage to be wrong, after all that you could go ahead and probably be able to do a small claims if they come back and say they are wrong.

I self-paid, so I am not sure about insurance at all. I am only referencing an article I read recently.

[illgeturhairdid 176]

As someone who deals with insurance companies and precert everyday... I know that what you are told is not promise of payment. I would probably ask your cooridinator at the doctor submit everything anyway and get something in writing say it doesn't require precert. I also know that should they deny the claim your surgeons office will end up telling you that it was your job to know your policy. Chances are it doesn't require precert if two people have already been told that, but it can't hurt to get it in writing!

Good luck and congrats!

[Tana_Q 20]

Thanks for the suggestions, I appreciate it. My sister is good with insurance issues so I am going to ask her for some assistance in how to deal with this too.