Advice on insurance and paperwork?

[Catherine Gray 11]

On December 18, my surgeon's office sent my paperwork to BCBS fir approval. Wrll denial, so I can get the approval through my secondary. Anyways, I started calling the day after to makr sure they got it. Well 7 business days later they still dont have it. They said it only takes a day or 2 to receive.

My question is should I call the doctors office back and keep hounding them? I called twice, and the lady said she sent it. She also said that she needs the denial letter from primary. But when I talk to secondary, they said all they have to do is do the surgery, bill them and they will pay. My secondary is Horizon NJ health.

Anyadvice? I dont want to be a nuisance but I also dont want to procrastinate.

[Catherine Gray 11]

Sorry for the typos I was using voice to text :-(

[BLERDgirl 6,417]

I would give them few days. Things may be delayed with the holidays. Maybe wait until the end of next week to follow up.

[Jlkhollins 38]

I found that I really had to stay on top of everyone to make this happen. When I had my psychological eval the psychologist took two and a half weeks to send documentation. This was after she said it would be sent within three days. (I am a psychologist...I know how long it takes to write these reports...not three weeks). I also stayed in contact with the surgeon/insurance and made sure everyone was communicating. I believe this helped to get a quick approval and now i am headed into surgery January 29. Good luck! Don't be afraid to advocate for yourself!

Jennifer

[Sharon1964 2,530]

But when I talk to secondary, they said all they have to do is do the surgery, bill them and they will pay. My secondary is Horizon NJ health.

I've been working in medical administration for over 15 years. I have NEVER had a secondary insurance that will "just pay" if you bill them (not saying they don't exist, just that I've never seen it)... although I've never worked with Horizon NJ Health.

Generally, the secondary follows the decisions of the primary unless you get something different in writing. So if your primary insurance does not cover a procedure, your secondary has two options: follow along with the denial or cover as if they were primary.

I would never counsel anyone on my team to perform a procedure without a written authorization/approval from the secondary in your situation. The likelihood that we would get paid for it would be slim.

[Catherine Gray 11]

I've been working in medical administration for over 15 years. I have NEVER had a secondary insurance that will "just pay" if you bill them (not saying they don't exist, just that I've never seen it)... although I've never worked with Horizon NJ Health.

Generally, the secondary follows the decisions of the primary unless you get something different in writing. So if your primary insurance does not cover a procedure, your secondary has two options: follow along with the denial or cover as if they were primary.

I would never counsel anyone on my team to perform a procedure without a written authorization/approval from the secondary in your situation. The likelihood that we would get paid for it would be slim.

They will cover as primary. Yet my primary still hasnt received any information which is stressful. I have everything ready to go for the 20thm and kust want to know it ok. if i dont hear bk by Wednesday i will be calling.

[Pinkgirl1234 761]

How do you like Dr Boynton?