Have you ever been charged a "precertification penalty"?

fortworthgal
on 5/22/09 4:28 am - Fort Worth , TX
I have BCBS Federal and since 2008 I have fighting with Doctors Hospital because they are trying to make me pay a $500 precertification penalty. My insurance requires precertification whenever you go in the hospital. The hospital did precertify me for a one night of diagnosis and observation but when I ended up staying 5 nights, they didnt bother to call my insruace company again to precertify me as inpatient for the remaining nights. They finally called my insurance company the day I was released. My insurance said they waited too long and as a result, deducted $500 from their payment to Doctors. And Doctors has told me I have to pay since my insurance wont. Anyone had this problem? Any advice?
If nothing else, I hope people who are going into the hospital remember this and make sure everything is done correctly by their insurance and the hospital so this doesnt happen to them.

I went from lap band to RNY on Aug 1 2008.
                 
                SW    CW  GW
5'2"     205/133/ ?







 

Kris M.
on 5/22/09 5:49 am - Near Dallas, TX
I'd be inclined to fight this tooth and nail since THEY didn't do THEIR job while YOU were laid up!  Go to the top!!!!
Kris M.   Ignorance is bliss...but not when you're aware of it!!
    
Phyllis M.
on 5/22/09 7:21 am - Irving, TX
I've never heard of this.    Kinda of like me in the hospital and the insurance ONLY paying for -in network prices when everyone at the hospitals are usually OUT OF NETWORK !!

FIGHT IT   FIGHT IT....FIGHT.  It is up to the hospital to get pre-auth or additional authorization if you are still IN THE HOSPITAL...that means you met that criteria and so - it should have been approved - DR'S ORDERS  so to speak...

  • Pease check out Dr. Connie Stapleton's Website. A lot of good information on there for all WLS patients regardless of the surgery you chose.  Good luck to all and I'm here for you if you want to send me an email.  I'll answer it as soon as possible.  
  • Total Lost:  139 lbs
  • Current Weight:  263  
  • As of 11-10-13 I have had weight gain.  Not happy about that.
  • RNY: 10-16-07 = 338:  Highest weight: 350+  Lowest Weight: 199 



 

  

  

fortworthgal
on 5/22/09 4:34 pm - Fort Worth , TX
Oh, Ive been dealing with this also. I ended up going back in the hospital a 3rd time and had 3 more operations and was in the hospital for almost a month and had all kinds of out of network doctors involved in my care that I had no control of..and I have paid some of them and am still fearful that some are going to send me bills.....I would imagine millions of people who have been sick or injured are dealing with these issues. 

I went from lap band to RNY on Aug 1 2008.
                 
                SW    CW  GW
5'2"     205/133/ ?







 

(deactivated member)
on 5/22/09 9:19 am - DFW area, TX
fortworthgal
on 5/22/09 4:41 pm - Fort Worth , TX

On my EOB it says I owe the $500.00 precertifcation penalty to the hospital. Ive argued this with my insurance company but they SOMEONE has to precertify me (so even if I was in a coma, if the hospital didnt do it, I should have done it or my family should have).

Ive had several 3 way calls but BCBS wont budge and so far the hospital wont budge. My thing is though why did the hospital do it on my other stays and on the first night of this stay but wait too late and make me responsible for it in the end. I will just keep on fighting.

I went from lap band to RNY on Aug 1 2008.
                 
                SW    CW  GW
5'2"     205/133/ ?







 

(deactivated member)
on 5/23/09 5:54 am - DFW area, TX
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