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Insurance Approval question? Insurance Approval question?

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  #1  
Unread 12-30-2006, 02:59 PM
Insurance Approval question?

I keep seeing threads where the insurance company is denying hysterectomies. My insurance company doesn't do preauthorizations unless it's for more than 3 days inpatient. They said they will pay if they feel it is medically necessary. Now I'm scared that afterward they will deny it and I'll be stuck with a humongous bill. Anyone else have this situation? We have a medical savings plan so I don't know if they will be ok or not. Any replies will be more than welcome! Thanks!
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  #2  
Unread 12-30-2006, 03:17 PM
Insurance Approval question?

Hi Diverchick,
Has your Doctor tried less invasive procedures that did not correct the problems that you are having? Sometimes this is what the insurance companies want to see. They are all different, I would call them and ask point blank, no one needs the added stress of not knowing if they are covered or not. I went through it myself, where I did not know if my coverage was there until the Thursday before a Monday surgery. I was a reck until then. I also was in touch with my hospital who had to get pre-approval before the surgery ( or else it would be canceled) , they actually told me before the insurance company did that all was a go. My hospital bill was over 25K so it was important for me to know if I was covered or not. I wish you all the best.
  #3  
Unread 12-30-2006, 07:42 PM
Insurance Approval question?

I just got my authorization letter in the mail today. They're giving me 2 days inpatient. I was worried about coverage as well, but it all turned out okay.
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  #4  
Unread 12-30-2006, 07:46 PM
Insurance Approval question?

Diverchick,

Check with your doctor's office. Usually they have a person who handles all of their surgical schedules along with the insurance for these procedures. Usually they get precertification for you. They can also give you an ESTIMATE of what your portion will be.
  #5  
Unread 12-30-2006, 10:23 PM
Insurance Approval question?

My insurance company said the same thing, the hospital told me not to worry they always say that. They did tell me that they would only approve a 1 night stay and they would only pay beyond that if it was an absolute medical necessity so I was out the door the next afteroon because I was so worried they wouldn't pay even though the doctor wanted me to stay 2 originally so make sure you check on how many nights they approve.
  #6  
Unread 12-30-2006, 10:36 PM
Insurance Approval question?

  Quote:
Originally Posted by diverchick
I keep seeing threads where the insurance company is denying hysterectomies. My insurance company doesn't do preauthorizations unless it's for more than 3 days inpatient. They said they will pay if they feel it is medically necessary. Now I'm scared that afterward they will deny it and I'll be stuck with a humongous bill. Anyone else have this situation? We have a medical savings plan so I don't know if they will be ok or not. Any replies will be more than welcome! Thanks!

Hi Diverchick - I agree with Plant lady. If you have had less invasive procedures the insurance is more likely to give the green light. Also, if you are with an HMO they are often times less likely to give it a thumbs up unless you have tried other things. I am the benefits specialist for a school district, so get to work on these things on a regular basis. Having said that, if there is a demonstrable (as in able to be tested and shown on ultrasound or other diagnostic equipment) problem, then the answer is most often yes. The main time I have seen an issue is if it is due to unusually heavy periods and pain. Since the insurance companies consider this subjective, they sometimes balk. Good luck!
  #7  
Unread 12-30-2006, 10:37 PM
Insurance Approval question?

My insurance does not require pre-cert for out-patient surgery. I am having a TLH that usually only requires up to a 23hr stay on special unit. I have to admit it makes me a little nervous. However these are their rules not ours, so I feel confident everything will work out.

Sherri
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