BCBS Pre Approval

I called my surgeon's office the other day and they said that as of April 1 we don't have to get pre approval for surgeries... This just basically means that I can go ahead with it and if they turn me down later I have to pay for it... right? I didn't have time to talk to the lady about it. Any thoughts?

Hey, when were you next to the cup??  I'm jealous!

Oh yea surgery....  I did read somehting like that on the BC web site the other day (I work in medical), if I were you, to cover my ass, I would definately call them and get the name of ther person you talk to.  If you have an individual policy, it's still not covered, so cover you hind end and call.  But that's just me, they lie to me every day LOL!!!

Good luck,

Edie

Hey girly, I have BCBS of MI. And My hospital wanted a Pre-Determination NOT pre-authorization. They wanted them to cross check to see if they have the info they are asking for. I did get an "approval" from BCBS of MI. However, it was for pre-determination and for my in-patient stay for up to 7days in the hopsital. good luck!

Does that mean that they are just going to cover the hospital stay? I've been told so many different things (by them!) that I can't keep it straight. One day they tell me the surgery will be covered, the next it won't be at all... the next they'll cover JUST the surgery...They're killin me here! 

The Pre-Determination was for the OpenRny and the Pre-Authorization/Certification was for my In-Patient Stay up to 7 days. You might want to have your hospital insurance call. I wasn’t able to get any information on the customer service side. The provider had to call the providers side! Good Luck!

I would definately call BCBS back and ask them for their name and keep good notes of who you talk to and the date & time.  If they tell you you don't need pre Approval or Pre determination, ask them to forward you a copy of the policy where it states that specifically for bariatric surgery.  Some companies have insurance policies that cover surgeries with exceptions.  My friend had insurance that would cover bariatric surgery, but her company had put a stipulation on the policy that for their employees, weight loss surgery was not covered.  I would also check with your employer regarding their policy specifics.  You don;t want to be caught in the end owing tens of thousands of dollars.