how are approvals handled?

[taweedeegirl 68]

I called my insurance company and the representative advised me that my medical group is the one who would have the final say so in regards of my surgery being approved or not

and if it was denied that is in United healthcare would go over all the paperwork is this true?

I was under the impression that all the paperwork would be done at my doctors office and then submitted to United healthcare(..just my logic)

[ladycook9713 442]

I don't think that rep knows what they are talking about.

Surgeons office puts everything together and submits to insurance. If you are wanting to check on it then you won't be speaking with a regular rep. Follow the options to check on a claim. Then tell the person you are wanting to check on the approval status for claim that was submitted. They will be able to give you a lot more information.

Btw, when you call in if you have been approved ask the person for the approval number and then call and give it to your surgeons office. That will get the ball rolling quicker than having to wait for the approval to reach your surgeons office. That's what I did and I received the approval letter in the mail the day AFTER my surgery

[BLERDgirl 6,417]

The insurance company calls the shots as to how paperwork is submitted because they are the ones paying for it. If that's what they said, then that's how it has to be done. You can talk to the 2 offices and see how they can coordinate together, but ultimately if the insurance company doesn't receive the request in the correct manner, they can deny the claim.

Not all insurance program work the same. Some want the request to come from the PCP, others will allow the bariatric program to make the request.

Edited March 31, 2015 by BLERDgirl