Insurance company does approval through a third party?

[Bjornsyouruncle 0]

My insurance is MedCost, but it is managed by a cooperative benefits organization (my husband works for a co-op). They use a third party company to handle specialized care (wls, infertility, cancer, etc) and the third party company determines if your case warrants surgery or not. After they make a determination they send a letter to the insurance company telling them their findings.

I'm not sure what happens after that, if the insurance company does any further review or if they just accept the decision of the third party company.

Has anyone else had to go through something like this?

Thanks,

Tammy

[Jodi_620 37]

My insurance company (United Healthcare) did it that way too. My approval letter came from a third party. There were no issues with it, approval came within a week and the letter came with an approval code to reference when interacting with insurance.

Edited January 9, 2009 by Jodi_620

[jujuvee 0]

I have United Health but am going through their 3rd party called Optum Health. My last appointment before approval is Feb 3rd.

Good luck

[Bjornsyouruncle 0]

I got this from my doctor's office:

Got a message on my voice mail today from yours nurse [at the 3rd party company] they have recommended surgery is medically necessary and have sent your clinicals to CBA [insurance company]. They are the ones that do the approvals for them. We should know in the next few days if it has been approved. I will keep you posted.

So I guess I'm just waiting to hear.