Insurance and Dr's office discrepancy

[Newsoulz 11]

Any body have your insurance tell you one thing and your Dr tell you something different about the pre-approval requirements. In Nov the insurance company told me 6 months and my Dr said the same in Dec. A few weeks ago my Dr office called and said I only needed 3 months. I got excited but now I can't verify that info with my insurance company. I have Anthem BCBS GA. Anyone have a similar situation.

[Aran1030 26]

I have Anthem BCBS CA , my doctors office told me 6 months . Tomorrow I'm going to call my insurance and see what the requirements are . I guess I will see if it's the same

[Newsoulz 11]

I have Anthem BCBS CA , my doctors office told me 6 months . Tomorrow I'm going to call my insurance and see what the requirements are . I guess I will see if it's the same

The ins company told my Dr that my plan pays under BCBS local and it only requires 3 months. I'd never heard of a plan paying differently than the type of plan you are a member of.

Good luck and hopefully no issues ahead.

[blessedgirl80 3]

The doctor office told me 6 month and insurance verified that I only needed 3 months. My policy was unique to my employer. I have Anthem BCBS their standard policy is 6 months of visits. The lady at the doctor office said she never heard of it. So I had the insurance company send a verification letter to me and I forwarded to the doctors office.

Edited March 2, 2017 by blessedgirl80

[GMen88 70]

I have Anthem BCBS CA and I was required to do 6 months. My bariatric surgeon's office called my insurance to verify that during my consultation

[aprilsdiamond 30]

Same happened to me. I think when you have insurance through your employer, the specifics of the policy can differ depending on what the employer and insurance company agree on.

[Diana_in_Philly 1,426]

Almost every employer-based policy is different, particularly if you work for a really big (e.g. Fortune 500) company. They have negotiating power with the health insurers. Never assume that because someone else who was insured by the same company got a certain answer, that answer will apply to you. They may have had a very different policy. It's one thing that 25+ years of practicing law has taught me.

[Newsoulz 11]

Same happened to me. I think when you have insurance through your employer, the specifics of the policy can differ depending on what the employer and insurance company agree on.

That's what they told me today. The utilization management dept called me back today and conformed that my plan doesn't have a specific time frame and that it is based on how my Dr thinks I've progressed. I must being doing good because they submitted everything yesterday so now I just wait to see if I get approved!

[Newsoulz 11]

Almost every employer-based policy is different, particularly if you work for a really big (e.g. Fortune 500) company. They have negotiating power with the health insurers. Never assume that because someone else who was insured by the same company got a certain answer, that answer will apply to you. They may have had a very different policy. It's one thing that 25+ years of practicing law has taught me.

That's what my ins peeps told me today. They finally called back and said my plan is different and there's no set time frame. I'm waiting now to find out if I got approved or not.

[Newsoulz 11]

The doctor office told me 6 month and insurance verified that I only needed 3 months. My policy was unique to my employer. I have Anthem BCBS their standard policy is 6 months of visits. The lady at the doctor office said she never heard of it. So I had the insurance company send a verification letter to me and I forwarded to the doctors office.

I didn't have them send a letter but they did confirm today that there isn't a set time frame for my specific plan. They did make notes in my file that they confirmed the info so now I'm waiting for an approval!