Insurance Did Not Pay for Pre-op Tests - Uh Oh - What will happen?

Posted in RNY board as well... 

I have Bluelincs HMO, part of Blue Cross Blue Shield, and it is really great insurance.  I had all of my pre-op tests a few weeks ago (Pulmonary, Cardiology, Lab) and I just received the EOB saying that they denied payment because the provider did not get preauthorization or preapproval.  While the EOB did say I was not responsible for the charges, I hope it will not get in the way of my surgery.  What are your thoughts?

I will have surgery at the same facility that did all the testing.  I want them to get there money so maybe there is somethign they can do, but most of all I don't want it to get in the way of my surgery.

-Danny

Hi Danny,
Hey you should get a copy of your Plan Docs from your employer or Insurance company. It details what it pays for when and how...

As far as billing goes I would let them fight it out, they could of billed it wrong to the INS company or used the wrong codes or the office codes could be wrong. In any case they are the experts here and you will probably just add another layer to the mix.

It does seem a bit weird to get pre-auth for doctor ordered tests but what the heck do I know...The docs office should of pulled your ins requirements before giving you the tests...

You haven't submitted pre-auth for your surgery yet?

Hugs
G

 It is wierd that they are needed preauthorization for those tests which was why I was a little concerned.  I'll wait and see what happens.

I'm hoping they'll submit for surgery preauthorization soon.  They're waiting to see if my documentation fulfills the six-month diet within the last 24 months.  I'm pretty sure it does but they want to be very sure.  I have a few appointments left to fulfill the surgeons requirements with my last dietician appointment on June 8th.  I'm hoping to have the surgery shortly thereafter.  I'm waiting...impatiently. :)

Thanks,

Danny